Abstract 1887: Statins and Risks for Death and Hospitalization in Heart Failure
Background: The influence of statin therapy on mortality and morbidity in heart failure (HF) has not been well described in a propensity matched cohort with subgroups of HF. The objective of this study was to determine if statins were associated with clinical outcomes in patients discharged after hospitalization with HF.
Methods: Patients admitted to Ontario hospitals between April 1, 1999 and March 31, 2001 with HF were identified in the Enhanced Feedback For Effective Cardiac Treatment (EFFECT) study. Patients discharged alive with a statin prescription were compared to those who were not. Five-year outcomes were examined in the overall cohort as well as 4 subgroups: those with (CAD) and without (NoCAD) coronary artery disease; those with preserved (DHF) and reduced (SHF) ejection fraction. Patients were matched using propensity score methods to ensure comparable risk.
Results: Of the 6451 patients identified, 1121 were discharged with a prescription for a statin (17.4%). The average age of patients in the study was 74.8 ± 11.5 (SD) years, and 49.3% were female. Patients discharged on statins were younger (70.3 vs. 75.8 years, p<0.001), but were more likely to have hypertension (60.9% vs. 47.7%, p<0.001), dyslipidemia (73.3% vs. 10.3%, p<0.001), diabetes (48.6% vs. 34.7%, p<0.001), peripheral vascular disease (18.5% vs. 11.9%, p<0.001) and coronary disease (89.4% vs. 69.8%, p<0.001). In a Cox proportional hazards model that adjusted for clinical covariates, statins were associated with improved 5-year mortality in the overall cohort (HR 0.85, 95% CI, 0.72 to 1.00, p=0.05) and in the CAD group (HR 0.79, 95% CI, 0.67 to 0.94, p=0.008) but not in the NoCAD, DHF or SHF groups. Statins were associated with lower 5-year rates of the combined endpoint, including death, readmission for HF, admission for coronary events or ischemic stroke in the CAD group (HR 0.85, 95% CI, 0.72 to 1.00, p=0.045) but not in the overall, NoCAD, DHF or SHF groups.
Conclusions: Among patients discharged from hospital with HF, only 17.4% received statin therapy. After propensity matching, statin therapy was associated with significantly improved outcomes in the overall cohort and in patients with CAD. Stratification by ejection fraction did not impact the effect of statins in patients with HF.