Carine E Hamo1, Gregg C Fonarow2, Stephen J Greene3, Muthiah Vaduganathan4, Clyde W Yancy5, Paul Heidenreich6, Di Lu7, Roland A Matsouaka8, Adam D DeVore3, Javed Butler9. 1. Division of Cardiology, Johns Hopkins University, Baltimore, MD. 2. Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA. 3. Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC. 4. Brigham and Women's Hospital Heart & Vascular Center, Boston, MA. 5. Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL. 6. Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA. 7. Duke Clinical Research Institute, Durham, NC. 8. Duke Clinical Research Institute, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC. 9. University of Mississippi Medical Center, Jackson, MS. Electronic address: Jbutler4@umc.edu.
Abstract
BACKGROUND: Postdischarge mortality following hospitalization for heart failure with reduced ejection fraction (HFrEF) has remained high and unchanged over the past 2 decades, despite effective therapies for HFrEF. We aimed to explore whether these patterns could in part be explained by changes in longitudinal risk profile and HF severity over time. METHODS: Among patients hospitalized for HF in the GWTG-HF registry from January 2005 to December 2018 with available data, we evaluated GWTG-HF and ADHERE risk scores, observing in-hospital mortality per-year. The risk profiles and outcomes were described overall and by subgroups based on ejection fraction (EF), diabetes mellitus (DM), sex, and age. RESULTS: Overall, 335,735 patients were included (50% HFrEF, 46% DM, 48% female, mean age 74 years). In-hospital mortality increased by 2.0% per year from 2005 to 2018. There was no significant change in mean GWTG-HF risk score overall or when stratified by EF groups (P = 0.46 HFrEF, p = 0.26 HF mid-range EF [HFmrEF], and P = 0.72 HF preserved EF [HFpEF]), age, sex, or presence of DM. The observed/expected ratio based on the GWTG-HF risk score was 0.93 (0.91-0.96), 0.83 (0.77-0.90), 0.92 (0.89-95) for HFrEF, HFmrEF, and HFpEF, respectively. Similar findings were seen when risk was assessed using ADHERE risk score. CONCLUSIONS: There were no significant changes in average risk profiles among hospitalized HF patients over the study duration. These data do not support the notion that worsening risk profile explains the lack of improved outcomes despite therapeutic advances, underscoring the importance of aggressive implementation of guideline-recommended therapies and investigation of novel treatments.
BACKGROUND: Postdischarge mortality following hospitalization for heart failure with reduced ejection fraction (HFrEF) has remained high and unchanged over the past 2 decades, despite effective therapies for HFrEF. We aimed to explore whether these patterns could in part be explained by changes in longitudinal risk profile and HF severity over time. METHODS: Among patients hospitalized for HF in the GWTG-HF registry from January 2005 to December 2018 with available data, we evaluated GWTG-HF and ADHERE risk scores, observing in-hospital mortality per-year. The risk profiles and outcomes were described overall and by subgroups based on ejection fraction (EF), diabetes mellitus (DM), sex, and age. RESULTS: Overall, 335,735 patients were included (50% HFrEF, 46% DM, 48% female, mean age 74 years). In-hospital mortality increased by 2.0% per year from 2005 to 2018. There was no significant change in mean GWTG-HF risk score overall or when stratified by EF groups (P = 0.46 HFrEF, p = 0.26 HF mid-range EF [HFmrEF], and P = 0.72 HF preserved EF [HFpEF]), age, sex, or presence of DM. The observed/expected ratio based on the GWTG-HF risk score was 0.93 (0.91-0.96), 0.83 (0.77-0.90), 0.92 (0.89-95) for HFrEF, HFmrEF, and HFpEF, respectively. Similar findings were seen when risk was assessed using ADHERE risk score. CONCLUSIONS: There were no significant changes in average risk profiles among hospitalized HF patients over the study duration. These data do not support the notion that worsening risk profile explains the lack of improved outcomes despite therapeutic advances, underscoring the importance of aggressive implementation of guideline-recommended therapies and investigation of novel treatments.
Authors: Abhinav Sharma; Xin Zhao; Bradley G Hammill; Adrian F Hernandez; Gregg C Fonarow; G Michael Felker; Clyde W Yancy; Paul A Heidenreich; Justin A Ezekowitz; Adam D DeVore Journal: Circ Heart Fail Date: 2018-06 Impact factor: 8.790
Authors: Emelia J Benjamin; Salim S Virani; Clifton W Callaway; Alanna M Chamberlain; Alexander R Chang; Susan Cheng; Stephanie E Chiuve; Mary Cushman; Francesca N Delling; Rajat Deo; Sarah D de Ferranti; Jane F Ferguson; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Pamela L Lutsey; Jason S Mackey; David B Matchar; Kunihiro Matsushita; Michael E Mussolino; Khurram Nasir; Martin O'Flaherty; Latha P Palaniappan; Ambarish Pandey; Dilip K Pandey; Mathew J Reeves; Matthew D Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Uchechukwu K A Sampson; Gary M Satou; Svati H Shah; Nicole L Spartano; David L Tirschwell; Connie W Tsao; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2018-01-31 Impact factor: 29.690
Authors: Pamela N Peterson; John S Rumsfeld; Li Liang; Nancy M Albert; Adrian F Hernandez; Eric D Peterson; Gregg C Fonarow; Frederick A Masoudi Journal: Circ Cardiovasc Qual Outcomes Date: 2009-12-08
Authors: Gabriella C Silva; Lan Jiang; Roee Gutman; Wen-Chih Wu; Vincent Mor; Michael J Fine; Nancy R Kressin; Amal N Trivedi Journal: JAMA Intern Med Date: 2020-03-01 Impact factor: 21.873
Authors: Joel B Braunstein; Gerard F Anderson; Gary Gerstenblith; Wendy Weller; Marlene Niefeld; Robert Herbert; Albert W Wu Journal: J Am Coll Cardiol Date: 2003-10-01 Impact factor: 24.094
Authors: Alexander T Sandhu; Rebecca L Tisdale; Fatima Rodriguez; Randall S Stafford; David J Maron; Tina Hernandez-Boussard; Eldrin Lewis; Paul A Heidenreich Journal: Circ Heart Fail Date: 2021-07-27 Impact factor: 10.447