Healthcare utilization and guideline-directed medical therapy in heart failure patients with reduced ejection fraction
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: This study examines the effect of guideline-directed medical therapy (GDMT) on healthcare utilization in patients with heart failure with reduced ejection fraction from Optum® Integrated File from 1 January 2007 to 30 June 2020. Materials & methods: Patients with both a beta blocker and either an ACE inhibitor (ACE-I), angiotensin receptor blocker (ARB) or angiotensin receptor neprilysin inhibitor were assigned to the GDMT cohort. All others were not on GDMT. Results: Estimated annual all cause hospitalizations and emergency department visits per 100 patients was 29% (80 vs 62 patients) and 26% higher (54 vs 43 patients; p < 0.0001) and annualized hospital days were longer (1.88 vs 1.64; p = 0.0020) for patients not on GDMT. Conclusion: In a real-world population, heart failure with reduced ejection fraction, patients not optimally managed on GDMT had higher annualized healthcare utilization when compared with patients on GDMT.
Formats available
You can view the full content in the following formats:
References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Centers for Disease Control and Prevention – National Center for Health Statistics. Underlying Cause of Death 1999–2016 on CDC WONDER online database, released December 2017. Data Are from the Multiple Cause of Death Files, 1999–2016, as Compiled from Data Provided by the 57 Vital Statistics Jurisdictions through the Vital Statistics Cooperative Program.(2017). http://wonder.cdc.gov/ucd-icd10.html
2.
Urbich M, Globe G, Pantiri K et al. A systematic review of medical costs associated with heart failure in the USA (2014–2020). Pharmacoeconomics 38(11), 1219–1236 (2020).
• Provides detailed breakdowns of various heart failure (HF)-related costs to better examine the economic burden of the condition, concluding that the key driver of costs is hospitalization.
3.
Reddy YNV, Borlaug BA. Readmissions in heart failure: it's more than just the medicine. Mayo Clin. Proc. 94(10), 1919–1921 (2019).
4.
Ziaeian B, Fonarow GC. The prevention of hospital readmissions in heart failure. Prog. Cardiovasc. Dis. 58(4), 379–385 (2016).
5.
Yancy CW, Jessup M, Bozkurt B et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. J. Am. Coll. Cardiol. 62(16), e147–239 (2013).
6.
Deschaseaux C, McSharry M, Hudson E, Agrawal R, Turner SJ. Treatment initiation patterns, modifications, and medication adherence among newly diagnosed heart failure patients: a retrospective claims database analysis. J. Manag. Care Spec. Pharm. 22(5), 561–571 (2016).
• An examination of treatment patterns for newly diagnosed HF patients in the USA, looking at modifications, hospitalizations and treatment adherence.
7.
Optum Inc., Clinformatics® Data Mart (2017). www.optum.com/content/dam/optum3/optum/en/resources/white-papers/clinformatics-data-mart.pdf
8.
Naegele M, Flammer AJ, Enseleit F, Ruschitzka F. Medical therapy of heart failure with reduced ejection fraction: current evidence and new developments. Swiss Med. Wkly 146, w14295 (2016).
9.
Sanam K, Bhatia V, Bajaj NS et al. Renin-angiotensin system inhibition and lower 30-day all-cause readmission in Medicare beneficiaries with heart failure. Am. J. Med. 129(10), 1067–1073 (2016).
10.
Gilstrap LG, Fonarow GC, Desai AS et al. Initiation, continuation, or withdrawal of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and outcomes in patients hospitalized with heart failure with reduced ejection fraction. J. Am. Heart Assoc. 6(2), e004675 (2017).
11.
McMurray JJ, Packer M, Desai AS et al. PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N. Engl. J. Med. 371(11), 993–1004 (2014).
12.
Hernandez AF, Hammill BG, O'Connor CM, Schulman KA, Curtis LH, Fonarow GC. Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry. J. Am. Coll. Cardiol. 53(2), 184–192 (2009).
• A combination of medicare claims data with records from the OPTIMIZE-HF trial that evaluates the effectiveness of beta blockers.
13.
Fonarow GC, Abraham WT, Albert NM et al. Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program. J. Am. Coll. Cardiol. 52(3), 190–199 (2008).
14.
Krum H, Roecker EB, Mohacsi P et al. Effects of initiating carvedilol in patients with severe chronic heart failure: results from the COPERNICUS study. JAMA 289(6), 712–8 (2003).
15.
Packer M, Coats AJ, Fowler MB et al. Carvedilol prospective randomized cumulative survival study group. Effect of carvedilol on survival in severe chronic heart failure. N. Engl. J. Med. 344(22), 1651–1658 (2001).
16.
Srivastava PK, DeVore AD, Hellkamp AS et al. Heart failure hospitalization and guideline-directed prescribing patterns among heart failure with reduced ejection fraction patients. JACC Heart Fail. 9(1), 28–38 (2021).
• An analysis of the relationship between guideline directed medical therapies changes and hospitalization.
17.
Greene SJ, Butler J, Albert NM et al. Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry. J. Am. Coll. Cardiol. 72(4), 351–366 (2018).
•• The CHAMP-HF (Change the Management of Patients with HF) registry is a study of HF with reduced ejection fraction outpatients that analyzed their treatment patterns and found only 1% of eligible patients were receiving target doses of the three indicated medication classes simultaneously.
18.
Bhagat AA, Greene SJ, Vaduganathan M et al. Initiation, continuation, switching, and withdrawal of heart failure medical therapies during hospitalization. JACC Heart Fail. 7(1), 1–12 (2019).
19.
Steinberg BA, Fang JC. Long-term outcomes of acute heart failure: where are we now? J. Am. Coll. Cardiol. 70(20), 2487–2489 (2017).
• An overview of various clinical trials and a look at the role of ejection fraction and hospitalization in treatment trajectories.
Information & Authors
Information
Published In
Pages: 1055 - 1063
PubMed: 34225473
Copyright
© 2021 Joanna Van Houten. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
History
Received: 20 May 2021
Accepted: 18 June 2021
Published online: 6 July 2021
Keywords:
Topics
Authors
Funding Information
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Healthcare utilization and guideline-directed medical therapy in heart failure patients with reduced ejection fraction. (2021) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2021-0118
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Joshua A. Jacobs, Tom Greene, Megan E. Vanneman, Jacob Kean, Spencer J. Carter, Kevin S. Shah, Ambarish Pandey, Catherine G. Derington, Alexander R. Zheutlin, James Fang, Josef Stehlik, Gregg C. Fonarow, Adam P. Bress, Time to Quadruple Therapy After Initial Diagnosis of Heart Failure With Reduced Ejection Fraction, JAMA Cardiology, 10.1001/jamacardio.2026.0375, 11, 6, (506), (2026).
- Radha Dhingra, Hanzhang Xu, Bradley G. Hammill, Scott M. Lynch, Jessica S. West, Michael D. Green, Eric D. Peterson, Lesley H. Curtis, Matthew E. Dupre, Association Between Socioeconomic Disadvantage and Risks of Early and Recurrent Admissions Among Patients With Newly Diagnosed Heart Failure, Circulation: Cardiovascular Quality and Outcomes, 10.1161/CIRCOUTCOMES.124.011141, 17, 12, (2024).