Kyle D O'Connor1, Todd Brophy2, Gregg C Fonarow3, Ron Blankstein4, Rajesh V Swaminathan1, Haolin Xu1, Roland A Matsouaka1,5, Nancy M Albert6, Eric J Velazquez7, Clyde W Yancy8, Paul A Heidenreich9,10, Adrian F Hernandez1, Adam D DeVore1. 1. Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (K.D.O., R.V.S., H.X., R.A.M., A.F.H., A.D.D.). 2. Department of Cardiovascular Medicine (T.B.). 3. Heart and Vascular Institute, Cleveland Clinic, OH. Division of Cardiology, University of California, Los Angeles (G.C.F.). 4. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (R.B.). 5. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.). 6. Nursing Institute, Office of Nursing Research and Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH (N.M.A.). 7. Division of Cardiology, Department of Medicine, Yale University School of Medicine, New Haven, CT (E.J.V.). 8. Division of Cardiology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL (C.W.Y.). 9. Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (P.A.H.). 10. Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA (P.A.H.).
Abstract
BACKGROUND: Current guidelines recommend evaluation for underlying heart disease and reversible conditions for patients with new-onset heart failure (HF). There are limited data on contemporary testing for coronary artery disease (CAD) in patients with new-onset HF. METHODS: We performed an observational cohort study using the Get With The Guidelines-Heart Failure registry linked to Medicare claims. All patients were aged ≥65 and hospitalized for new-onset HF from 2009 to 2015. We collected left ventricular ejection fraction (LVEF), prior HF history, and in-hospital CAD testing from the registry, as well as testing for CAD using claims from 90 days before to 90 days after index HF hospitalization. RESULTS: Among 17 185 patients with new-onset HF, 6672 (39%) received testing for CAD, including 3997 (23%) during the index hospitalization. Testing for CAD differed by LVEF: 53% in HF with reduced EF (LVEF ≤40%), 42% in HF with borderline EF (LVEF, 41%-49%), and 31% in HF with preserved EF (LVEF ≥50%). After multivariable adjustment, patients who received testing for CAD, compared with those who did not, were younger and more likely to be male, have a smoking history, have hyperlipidemia, and have HF with reduced ejection fraction or HF with borderline ejection fraction (all P<0.05). CONCLUSIONS: The majority of patients hospitalized for new-onset HF did not receive testing for CAD either during the hospitalization or in the 90 days before and after. The rates of testing for CAD were higher in patients with LVEF ≤40% though remained low. These data highlight an opportunity to improve care by identifying appropriate candidates for optimal CAD medical therapy and revascularization.
BACKGROUND: Current guidelines recommend evaluation for underlying heart disease and reversible conditions for patients with new-onset heart failure (HF). There are limited data on contemporary testing for coronary artery disease (CAD) in patients with new-onset HF. METHODS: We performed an observational cohort study using the Get With The Guidelines-Heart Failure registry linked to Medicare claims. All patients were aged ≥65 and hospitalized for new-onset HF from 2009 to 2015. We collected left ventricular ejection fraction (LVEF), prior HF history, and in-hospital CAD testing from the registry, as well as testing for CAD using claims from 90 days before to 90 days after index HF hospitalization. RESULTS: Among 17 185 patients with new-onset HF, 6672 (39%) received testing for CAD, including 3997 (23%) during the index hospitalization. Testing for CAD differed by LVEF: 53% in HF with reduced EF (LVEF ≤40%), 42% in HF with borderline EF (LVEF, 41%-49%), and 31% in HF with preserved EF (LVEF ≥50%). After multivariable adjustment, patients who received testing for CAD, compared with those who did not, were younger and more likely to be male, have a smoking history, have hyperlipidemia, and have HF with reduced ejection fraction or HF with borderline ejection fraction (all P<0.05). CONCLUSIONS: The majority of patients hospitalized for new-onset HF did not receive testing for CAD either during the hospitalization or in the 90 days before and after. The rates of testing for CAD were higher in patients with LVEF ≤40% though remained low. These data highlight an opportunity to improve care by identifying appropriate candidates for optimal CAD medical therapy and revascularization.
Authors: Jimmy Zheng; Paul A Heidenreich; Shun Kohsaka; William F Fearon; Alexander T Sandhu Journal: J Am Coll Cardiol Date: 2022-03-08 Impact factor: 27.203
Authors: Erin McGuinn; Theodore Warsavage; Mary E Plomondon; Javier A Valle; P Michael Ho; Stephen W Waldo Journal: J Am Heart Assoc Date: 2021-02-15 Impact factor: 5.501