Abstract 13518: Examining the ‘Lifetime Risk’ of Hospitalizations and Invasive Cardiac Procedures in Heart Failure (HF): Differences Based on Left Ventricular Systolic Function, Ischemic Disease, and Sex
Background: Despite its prevalence, population-based data on the “real world” burden of HF on the health care system during the lifetime of the patient are limited.
Methods: We examined rates of hospitalization for HF, cardiovascular (CV) and non-CV disease, and procedures occurring during the lifetime of patients discharged after the first hospitalization for HF, and compared systolic (SHF) vs diastolic HF (DHF), ischemic (IHF) vs non-ischemic HF (NIHF) and by sex. Patients in the Enhanced Feedback For Effective Cardiac Treatment (EFFECT) HF Study, Ontario, Canada (1999–2001) were examined — most patients (>98%) are now deceased. Invasive interventions included coronary angiogram, revascularizations, implantable devices, valvular surgery, electrical cardioversion, ablation, and peripheral vascular interventions.
Results: Among 8463 study patients (77±10 years, 4092 male), 61% had IHF and 67% with LV functional assessment (n=3604) had SHF. During their lifetime, there were 35,840 CV (10,377 for HF) and 20,807 non-CV hospitalizations, and 2017 interventions. Age/sex-adjusted rates of HF hospitalization (per 100 person-years) were significantly higher for SHF vs DHF (57.7 vs 49.5), men vs women (60.8 vs 58.0) and in IHF vs NIHF (67.1 vs 47.5) patients (all p<0.001). Use of invasive procedures (per 100 person-years) were higher for SHF vs DHF (12.7 vs 11.8), men vs women (12.6 vs 8.6) and in IHF vs NIHF (11.6 vs 9.2) patients (all p<0.001). Women with DHF had greater HF admissions than men (52.5 vs 47.4, p<0.001), yet they underwent cardiac invasive procedures significantly less often (9.6 vs 13.9, p<0.001). On multivariable analysis, IHF predicted repeated HF admissions (HR 1.18, 95%CI; 1.12–1.25, p<0.001) whereas SHF and male sex did not. IHF (HR 1.19, 95%CI; 1.07–1.32, p=0.002) and male sex (HR 1.34, 95%CI; 1.20–1.50, p<0.001) were predictors of invasive interventions; SHF was not associated with higher invasive cardiac procedure use.
Conclusions: Over the lifetime, higher rates of HF and CV hospitalizations and use of invasive cardiac procedures were associated with SHF, IHF, and male sex. IHF was a significant predictor of HF hospitalization and greater use of invasive cardiac procedures.
- © 2010 by American Heart Association, Inc.