Abstract 15201: Initial HFrEF Pharmacotherapy Choice is Associated With 2-Year Mortality
Introduction: Risk factors associated with increased mortality for patients (pts) with HFrEF have been examined in prior studies, but the impact of real world initial pharmacotherapy (IPT) as a risk factor for mortality is not well understood.
Hypothesis: Choice of IPT is associated with risk of 2 year (yr) mortality in HFrEF pts.
Methods: This retrospective cohort study identified Humana Medicare pts with ≥ 2 claims for HF from Aug 2010 to Jul 2015. The 1st HF claim was the index date. Pts had no HF diagnosis pre-index, and had continuous enrollment 1-yr pre- and 2-yr post-index or until death. A claims-based algorithm was used to derive HFrEF status. Receipt of mono- or combo-therapies of ace-inhibitor (ACEI), angiotensin II receptor blocker (ARB), beta blocker (BB), hydralazine-nitrate (HN), and aldosterone antagonist (AA) in 1 yr post-index was considered IPT. Receipt of none of these drugs, only 1 fill, or less than a 28 day supply in the 1st yr was considered no ITP. Concomitant use of diuretics was also reported. A Cox proportional hazards model with a time-dependent variable for treatment was used to assess the effect of IPT on 2-yr mortality post-index, adjusting for pre-index comorbidity, Charlson comorbidity index, socio-demographics, place of index HF claim and pre-index inpatient, ER and physician visits.
Results: Of 14,359 HFrEF pts, mean (SD) age was 75 (8) yrs, 45% were female and 12% were dually eligible for Medicare/Medicaid. Overall, 61% had IPT within 1 month post-index; 7% started after 1st month, 32% had no ITP in the 1st yr. The most common IPTs were 32% mono vasodilators (ACEI, ARB or HN), 16% mono vasodilator + BB, 11% mono BB, and 2% triple therapy [(ACEI or ARB) + BB + (HN or AA)]. Almost 2/3 of pts had diuretics. One- and 2-yr mortality rates were 17% and 28%, respectively. Compared to mono vasodilator therapy, pts initiating triple therapy had a 29% lower risk of death in 2 yrs (HR 0.71, 95% CI [0.53, 0.96]); whereas, those on mono BB (HR 1.35, 95% CI [1.21,1.52]) or no IPT (HR 2.26, 95% CI [2.08, 2.45]) had higher risk of death.
Conclusion: Despite presence of HF diagnosis, nearly 1/3 of HFrEF pts had no IPT within 1 yr post-index and over 25% died in 2 yrs. Since triple IPT was associated with lower 2-yr mortality risk, mono IPT should be minimized in favor of triple IPT.
Author Disclosures: N.M. Albert: Employment; Modest; Novartis Pharmaceuticals Corporation. D.A. Drzayich Antol: Employment; Modest; Comprehensive Health Insights. A. Waldman Casebeer: Employment; Modest; Comprehensive Health Insights. Ownership Interest; Modest; Comprehensive Health Insights. R.W. DeClue: Employment; Modest; Comprehensive Health Insights. Y. Li: Employment; Modest; Comprehensive Health Insights. Ownership Interest; Modest; Comprehensive Health Insights. E. Obi: Employment; Significant; Novartis Pharmaceuticals Corporation. S. Stemkowski: Employment; Modest; Comprehensive Health Insights. Ownership Interest; Modest; Comprehensive Health Insights. C. Chang: Employment; Significant; Novartis Pharmaceuticals Corporation.
- © 2016 by American Heart Association, Inc.