Abstract 18695: Signs, Symptoms, and Treatment Patterns Across Serial Ambulatory Cardiology Visits in Patients With Heart Failure: Insights From the PINNACLE Registry
Introduction: Heart failure (HF) guidelines recommend titration of diuretics to optimize volume status, as well as intensification of neurohoromonal antagonists as tolerated in certain patients. However, symptoms, signs, and prescribing patterns in real world ambulatory care are not well described.
Methods: We queried the PINNACLE Registry of 234 outpatient cardiology practices from 2008-2014 for adults with HF and ≥ 2 ambulatory visits < 1 year apart. For each pair of consecutive visits, the first was the index, and changes in symptoms (dyspnea, orthopnea, NYHA class), signs, and HF medications were assessed at the second visit. Medications were grouped into angiotensin converting enzyme inhibitor (ACE), angiotensin receptor blocker (ARB), beta blocker (BB), and any diuretic.
Results: There were 550,467 patients with 2,998,444 visit pairs. At index, symptoms included dyspnea in 53.6% and orthopnea in 23.1%. Signs ranged from 0.6% (hepatomegaly) to 52.2 % (peripheral edema). Index HF medications: 17.5% had no ACEI/ARB/BB, 35.1% either ACE/ARB or BB and 47.3% on both ACE/ARB + BB. Diuretics were used in 56.4% (4.3% diuretic only). In the subsequent year, patients had a mean 2.5 cardiology visits. Changes in symptoms/signs were infrequently recorded: dyspnea and orthopnea appeared in 3.8% and 1.8%, resolved in 2.7% and 1.6%, respectively; NYHA increased in 2.9%, decreased in 2.9%; and number of signs increased in 6.0%, decreased in 5.1%. Changes to HF medications were infrequent: ACE/ARB/BB or diuretic was added in 6.4% and 3.7%, stopped in 6.2% and 3.8%, respectively. Table 1 describes the association between changes in symptoms/signs and therapy.
Conclusions: In a rare look at real world HF care in US cardiology clinics, changes in symptoms, signs, and medications were infrequently reported and aligned. Although limited by missing LVEF and dosing information, results suggest opportunities for more proactive adjustment of HF medications in the ambulatory setting.
Author Disclosures: L.A. Allen: Research Grant; Significant; NIH/NHLBI, PCORI, AHA. Consultant/Advisory Board; Modest; Janssen, St Jude, ZS Pharma. Consultant/Advisory Board; Significant; Novartis Pharmaceuticals Coproration. F. Tang: None. P. Jones: None. T. Breeding: None. A. Ponirakis: None. S.J. Turner: Employment; Significant; Novartis Pharmaceuticals Corporation.
- © 2016 by American Heart Association, Inc.