Abstract P384: The Impact of Optimal Therapy on Survival of Hospitalized Acute Decompensated Heart Failure: The ARIC Study
Background: Despite guidelines for the treatment of heart failure (HF), many patients remain undertreated. We hypothesized that patients hospitalized with acute decompensated HF (ADHF) who are prescribed “optimal” or “acceptable” HF therapy will have better overall survival compared to those on a “nonoptimal” medical regimen.
Methods: The Atherosclerosis Risk in Communities (ARIC) Study conducted comprehensive surveillance of hospitalized HF events (age ≥55 years) in four US communities. “Optimal” pharmacotherapy was defined as ACE inhibitor or ARB, and beta-blocker, and/or aldosterone blocker; “acceptable” therapy was hydralazine and nitrate, and beta-blocker, and/or aldosterone blocker. Hospitalizations for HF from 2005-2011 were identified by ICD-9-CM codes, then validated by standardized physician review of hospital records, yielding 3575 hospitalizations validated as ADHF with left ventricular ejection fraction (EF) data, which corresponded to a weighted sample of 16,659 hospitalizations after accounting for the sampling design.
Results: Of the ADHF hospitalizations, 9772 (59%) were HF with reduced EF (HFrEF), 6882 (41%) were HF with preserved EF (HFpEF). HFrEF patients were younger (74 yrs), more often male (56%) and African-American (31%), with more coronary heart disease (CHD) and less hypertension and diabetes. Most ADHF patients were on "nonoptimal” (53%: 50% of which were HFrEF) or “optimal” therapy (43%: 68% HFrEF), and very few were on “acceptable” therapy (4%: 81% HFrEF). The lowest 28-day and 1-year case fatality occurred among patients on “optimal” therapy” (HFrEF 2.7%, 25.2%; HFpEF 4.5%, 21.0%), followed by those on “acceptable” therapy (HFrEF 4.4%, 39.7%; HFpEF 0%, 25.4%), and highest among those on “non-optimal” therapy (HFrEF 9.2%, 41.5%; HFpEF 6.5%, 34.8%), even after adjusting for HF type, age, race, teaching hospital status, CHD, hypertension, diabetes, chronic kidney or lung disease, inotrope therapy, prior hospitalization for HF (p<0.05 for comparison of optimal/acceptable vs non-optimal therapy groups).
Conclusions: Both “optimal” and “acceptable” therapies were associated with lower mortality regardless of EF. While confounding by indication may contribute to these findings, further study is needed to better understand why more than half of hospitalized ADHF patients were on “non-optimal” therapy.
Author Disclosures: P.P. Chang: None. L.M. Wruck: None. R.A. Kloss: None. L.R. Loehr: None. S.D. Russell: None. N.M. Punjabi: None. A.G. Bertoni: None. E.R. Miller: None. E. Shahar: None. W.D. Rosamond: None.
- © 2015 by American Heart Association, Inc.