Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population
Background Studies on outcomes among patients with heart failure (HF) with preserved left ventricular ejection fraction (HF p EF), borderline left ventricular ejection fraction (HF b EF), and reduced left ventricular ejection fraction (HF r EF) remain limited. We sought to characterize mortality and...
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| Veröffentlicht in: | The American heart journal 2014-11, Vol.168 (5), p.721-730.e3 |
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| creator | Cheng, Richard K., MD, MS Cox, Margueritte, MS Neely, Megan L., PhD Heidenreich, Paul A., MD, MS Bhatt, Deepak L., MD, MPH Eapen, Zubin J., MD, MHS Hernandez, Adrian F., MD, MHS Butler, Javed, MD, MPH Yancy, Clyde W., MD, MS Fonarow, Gregg C., MD |
| description | Background Studies on outcomes among patients with heart failure (HF) with preserved left ventricular ejection fraction (HF p EF), borderline left ventricular ejection fraction (HF b EF), and reduced left ventricular ejection fraction (HF r EF) remain limited. We sought to characterize mortality and readmission in patients with HF in the contemporary era. Methods Get With The Guidelines–HF was linked to Medicare data for longitudinal follow-up. Patients were grouped into HF p EF (left ventricular ejection fraction [EF] ≥50%), HF b EF (40% ≤ EF < 50%), and HF r EF (EF |
| doi_str_mv | 10.1016/j.ahj.2014.07.008 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1629973549</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S000287031400427X</els_id><sourcerecordid>1629973549</sourcerecordid><originalsourceid>FETCH-LOGICAL-c506t-449f58a3b9ed31900bd3ea6bac4a8d91df39bcfd1a8a6e87571a9f8c4dbbdc683</originalsourceid><addsrcrecordid>eNp9kl9r1jAUxoMo7t30A3gjAW-8WLuTNm0TBEGGU2FjFyp4F9LklDe1b1OTdjLwwy-lU2EXu8q_33k4eZ5DyCsGOQNWn_W53vd5AYzn0OQA4gnZMZBNVjecPyU7ACgy0UB5RI5j7NOxLkT9nBwVFecggO3In-tlNv6AkbqRTnp2OM6R_nbznu5Rh5l22g1LwO1qChgx3KA9pa0PFsPgRjylerQ0oF0MWoo9mtn5kXZBb5skPO-RXqF1RielyU_LoNenF-RZp4eIL-_XE_L94uO388_Z5fWnL-cfLjNTQT1nnMuuErpsJdqSSYDWlqjrVhuuhZXMdqVsTWeZFrpG0VQN07IThtu2taYW5Ql5u-lOwf9aMM7q4KLBYdAj-iUqVhdSNmXFZULfPEB7v4QxdZcolhhRCZ4otlEm-BgDdmoK7qDDrWKg1mhUr1I0ao1GQaNSNKnm9b3y0h7Q_qv4m0UC3m0AJituHAYVTYojmepC8lRZ7x6Vf_-g2qRwkuPDT7zF-P8XKhYK1Nd1NtbRYByAF82P8g7KZbXO</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1617358584</pqid></control><display><type>article</type><title>Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Cheng, Richard K., MD, MS ; Cox, Margueritte, MS ; Neely, Megan L., PhD ; Heidenreich, Paul A., MD, MS ; Bhatt, Deepak L., MD, MPH ; Eapen, Zubin J., MD, MHS ; Hernandez, Adrian F., MD, MHS ; Butler, Javed, MD, MPH ; Yancy, Clyde W., MD, MS ; Fonarow, Gregg C., MD</creator><creatorcontrib>Cheng, Richard K., MD, MS ; Cox, Margueritte, MS ; Neely, Megan L., PhD ; Heidenreich, Paul A., MD, MS ; Bhatt, Deepak L., MD, MPH ; Eapen, Zubin J., MD, MHS ; Hernandez, Adrian F., MD, MHS ; Butler, Javed, MD, MPH ; Yancy, Clyde W., MD, MS ; Fonarow, Gregg C., MD</creatorcontrib><description>Background Studies on outcomes among patients with heart failure (HF) with preserved left ventricular ejection fraction (HF p EF), borderline left ventricular ejection fraction (HF b EF), and reduced left ventricular ejection fraction (HF r EF) remain limited. We sought to characterize mortality and readmission in patients with HF in the contemporary era. Methods Get With The Guidelines–HF was linked to Medicare data for longitudinal follow-up. Patients were grouped into HF p EF (left ventricular ejection fraction [EF] ≥50%), HF b EF (40% ≤ EF < 50%), and HF r EF (EF <40%). Multivariable models were constructed to examine the relationship between EF and outcomes at 30 days and 1 year and to study trends over time. Results A total of 40,239 patients from 220 hospitals between 2005 and 2011 were included in the study: 18,897 (47%) had HF p EF, 5,626 (14%) had HF b EF, and 15,716 (39%) had HF r EF. In crude survival analysis, patients with HF r EF had slightly increased mortality compared with HF b EF and HF p EF. After risk adjustment, mortality at 1 year was not significantly different for HF r EF, HF b EF, and HF p EF (HF r EF vs HF p EF, hazard ratio [HR] 1.040 [95% CI 0.998-1.084], and HF b EF vs HF p EF, HR 0.967 [95% CI 0.917-1.020]). Patients with HF p EF had increased risk of all-cause readmission compared with HF r EF. Conversely, risk of cardiovascular and HF readmissions were higher in HF r EF and HF b EF compared with HF p EF. Conclusions Among patients hospitalized with HF, patients with HF p EF and HF b EF had slightly lower mortality and higher all-cause readmission risk than patients with HF r EF, although the mortality differences did not persist after risk adjustment. Irrespective of EF, these patients experience substantial mortality and readmission highlighting the need for new therapeutic strategies.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2014.07.008</identifier><identifier>PMID: 25440801</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Cardiovascular ; Cardiovascular disease ; Chronic obstructive pulmonary disease ; Cohort Studies ; Drug therapy ; Family medical history ; Female ; Fractions ; Heart attacks ; Heart failure ; Heart Failure - mortality ; Heart Failure - physiopathology ; Hospitalization ; Hospitals ; Humans ; Laboratories ; Male ; Medicare ; Mortality ; Multivariate Analysis ; Patient Readmission - statistics & numerical data ; Patients ; Prognosis ; Proportional Hazards Models ; Rehabilitation ; Retrospective Studies ; Review boards ; Stroke Volume - physiology ; Studies ; United States ; Variables ; Ventricular Dysfunction - mortality ; Ventricular Dysfunction - physiopathology</subject><ispartof>The American heart journal, 2014-11, Vol.168 (5), p.721-730.e3</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Nov 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c506t-449f58a3b9ed31900bd3ea6bac4a8d91df39bcfd1a8a6e87571a9f8c4dbbdc683</citedby><cites>FETCH-LOGICAL-c506t-449f58a3b9ed31900bd3ea6bac4a8d91df39bcfd1a8a6e87571a9f8c4dbbdc683</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S000287031400427X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25440801$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheng, Richard K., MD, MS</creatorcontrib><creatorcontrib>Cox, Margueritte, MS</creatorcontrib><creatorcontrib>Neely, Megan L., PhD</creatorcontrib><creatorcontrib>Heidenreich, Paul A., MD, MS</creatorcontrib><creatorcontrib>Bhatt, Deepak L., MD, MPH</creatorcontrib><creatorcontrib>Eapen, Zubin J., MD, MHS</creatorcontrib><creatorcontrib>Hernandez, Adrian F., MD, MHS</creatorcontrib><creatorcontrib>Butler, Javed, MD, MPH</creatorcontrib><creatorcontrib>Yancy, Clyde W., MD, MS</creatorcontrib><creatorcontrib>Fonarow, Gregg C., MD</creatorcontrib><title>Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Studies on outcomes among patients with heart failure (HF) with preserved left ventricular ejection fraction (HF p EF), borderline left ventricular ejection fraction (HF b EF), and reduced left ventricular ejection fraction (HF r EF) remain limited. We sought to characterize mortality and readmission in patients with HF in the contemporary era. Methods Get With The Guidelines–HF was linked to Medicare data for longitudinal follow-up. Patients were grouped into HF p EF (left ventricular ejection fraction [EF] ≥50%), HF b EF (40% ≤ EF < 50%), and HF r EF (EF <40%). Multivariable models were constructed to examine the relationship between EF and outcomes at 30 days and 1 year and to study trends over time. Results A total of 40,239 patients from 220 hospitals between 2005 and 2011 were included in the study: 18,897 (47%) had HF p EF, 5,626 (14%) had HF b EF, and 15,716 (39%) had HF r EF. In crude survival analysis, patients with HF r EF had slightly increased mortality compared with HF b EF and HF p EF. After risk adjustment, mortality at 1 year was not significantly different for HF r EF, HF b EF, and HF p EF (HF r EF vs HF p EF, hazard ratio [HR] 1.040 [95% CI 0.998-1.084], and HF b EF vs HF p EF, HR 0.967 [95% CI 0.917-1.020]). Patients with HF p EF had increased risk of all-cause readmission compared with HF r EF. Conversely, risk of cardiovascular and HF readmissions were higher in HF r EF and HF b EF compared with HF p EF. Conclusions Among patients hospitalized with HF, patients with HF p EF and HF b EF had slightly lower mortality and higher all-cause readmission risk than patients with HF r EF, although the mortality differences did not persist after risk adjustment. Irrespective of EF, these patients experience substantial mortality and readmission highlighting the need for new therapeutic strategies.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Cohort Studies</subject><subject>Drug therapy</subject><subject>Family medical history</subject><subject>Female</subject><subject>Fractions</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - physiopathology</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medicare</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Rehabilitation</subject><subject>Retrospective Studies</subject><subject>Review boards</subject><subject>Stroke Volume - physiology</subject><subject>Studies</subject><subject>United States</subject><subject>Variables</subject><subject>Ventricular Dysfunction - mortality</subject><subject>Ventricular Dysfunction - physiopathology</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kl9r1jAUxoMo7t30A3gjAW-8WLuTNm0TBEGGU2FjFyp4F9LklDe1b1OTdjLwwy-lU2EXu8q_33k4eZ5DyCsGOQNWn_W53vd5AYzn0OQA4gnZMZBNVjecPyU7ACgy0UB5RI5j7NOxLkT9nBwVFecggO3In-tlNv6AkbqRTnp2OM6R_nbznu5Rh5l22g1LwO1qChgx3KA9pa0PFsPgRjylerQ0oF0MWoo9mtn5kXZBb5skPO-RXqF1RielyU_LoNenF-RZp4eIL-_XE_L94uO388_Z5fWnL-cfLjNTQT1nnMuuErpsJdqSSYDWlqjrVhuuhZXMdqVsTWeZFrpG0VQN07IThtu2taYW5Ql5u-lOwf9aMM7q4KLBYdAj-iUqVhdSNmXFZULfPEB7v4QxdZcolhhRCZ4otlEm-BgDdmoK7qDDrWKg1mhUr1I0ao1GQaNSNKnm9b3y0h7Q_qv4m0UC3m0AJituHAYVTYojmepC8lRZ7x6Vf_-g2qRwkuPDT7zF-P8XKhYK1Nd1NtbRYByAF82P8g7KZbXO</recordid><startdate>20141101</startdate><enddate>20141101</enddate><creator>Cheng, Richard K., MD, MS</creator><creator>Cox, Margueritte, MS</creator><creator>Neely, Megan L., PhD</creator><creator>Heidenreich, Paul A., MD, MS</creator><creator>Bhatt, Deepak L., MD, MPH</creator><creator>Eapen, Zubin J., MD, MHS</creator><creator>Hernandez, Adrian F., MD, MHS</creator><creator>Butler, Javed, MD, MPH</creator><creator>Yancy, Clyde W., MD, MS</creator><creator>Fonarow, Gregg C., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20141101</creationdate><title>Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population</title><author>Cheng, Richard K., MD, MS ; Cox, Margueritte, MS ; Neely, Megan L., PhD ; Heidenreich, Paul A., MD, MS ; Bhatt, Deepak L., MD, MPH ; Eapen, Zubin J., MD, MHS ; Hernandez, Adrian F., MD, MHS ; Butler, Javed, MD, MPH ; Yancy, Clyde W., MD, MS ; Fonarow, Gregg C., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c506t-449f58a3b9ed31900bd3ea6bac4a8d91df39bcfd1a8a6e87571a9f8c4dbbdc683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Cohort Studies</topic><topic>Drug therapy</topic><topic>Family medical history</topic><topic>Female</topic><topic>Fractions</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - physiopathology</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medicare</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Patient Readmission - statistics & numerical data</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Rehabilitation</topic><topic>Retrospective Studies</topic><topic>Review boards</topic><topic>Stroke Volume - physiology</topic><topic>Studies</topic><topic>United States</topic><topic>Variables</topic><topic>Ventricular Dysfunction - mortality</topic><topic>Ventricular Dysfunction - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cheng, Richard K., MD, MS</creatorcontrib><creatorcontrib>Cox, Margueritte, MS</creatorcontrib><creatorcontrib>Neely, Megan L., PhD</creatorcontrib><creatorcontrib>Heidenreich, Paul A., MD, MS</creatorcontrib><creatorcontrib>Bhatt, Deepak L., MD, MPH</creatorcontrib><creatorcontrib>Eapen, Zubin J., MD, MHS</creatorcontrib><creatorcontrib>Hernandez, Adrian F., MD, MHS</creatorcontrib><creatorcontrib>Butler, Javed, MD, MPH</creatorcontrib><creatorcontrib>Yancy, Clyde W., MD, MS</creatorcontrib><creatorcontrib>Fonarow, Gregg C., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Physical Education Index</collection><collection>ProQuest - 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Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cheng, Richard K., MD, MS</au><au>Cox, Margueritte, MS</au><au>Neely, Megan L., PhD</au><au>Heidenreich, Paul A., MD, MS</au><au>Bhatt, Deepak L., MD, MPH</au><au>Eapen, Zubin J., MD, MHS</au><au>Hernandez, Adrian F., MD, MHS</au><au>Butler, Javed, MD, MPH</au><au>Yancy, Clyde W., MD, MS</au><au>Fonarow, Gregg C., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2014-11-01</date><risdate>2014</risdate><volume>168</volume><issue>5</issue><spage>721</spage><epage>730.e3</epage><pages>721-730.e3</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background Studies on outcomes among patients with heart failure (HF) with preserved left ventricular ejection fraction (HF p EF), borderline left ventricular ejection fraction (HF b EF), and reduced left ventricular ejection fraction (HF r EF) remain limited. We sought to characterize mortality and readmission in patients with HF in the contemporary era. Methods Get With The Guidelines–HF was linked to Medicare data for longitudinal follow-up. Patients were grouped into HF p EF (left ventricular ejection fraction [EF] ≥50%), HF b EF (40% ≤ EF < 50%), and HF r EF (EF <40%). Multivariable models were constructed to examine the relationship between EF and outcomes at 30 days and 1 year and to study trends over time. Results A total of 40,239 patients from 220 hospitals between 2005 and 2011 were included in the study: 18,897 (47%) had HF p EF, 5,626 (14%) had HF b EF, and 15,716 (39%) had HF r EF. In crude survival analysis, patients with HF r EF had slightly increased mortality compared with HF b EF and HF p EF. After risk adjustment, mortality at 1 year was not significantly different for HF r EF, HF b EF, and HF p EF (HF r EF vs HF p EF, hazard ratio [HR] 1.040 [95% CI 0.998-1.084], and HF b EF vs HF p EF, HR 0.967 [95% CI 0.917-1.020]). Patients with HF p EF had increased risk of all-cause readmission compared with HF r EF. Conversely, risk of cardiovascular and HF readmissions were higher in HF r EF and HF b EF compared with HF p EF. Conclusions Among patients hospitalized with HF, patients with HF p EF and HF b EF had slightly lower mortality and higher all-cause readmission risk than patients with HF r EF, although the mortality differences did not persist after risk adjustment. Irrespective of EF, these patients experience substantial mortality and readmission highlighting the need for new therapeutic strategies.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25440801</pmid><doi>10.1016/j.ahj.2014.07.008</doi><tpages>10</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Cardiovascular Cardiovascular disease Chronic obstructive pulmonary disease Cohort Studies Drug therapy Family medical history Female Fractions Heart attacks Heart failure Heart Failure - mortality Heart Failure - physiopathology Hospitalization Hospitals Humans Laboratories Male Medicare Mortality Multivariate Analysis Patient Readmission - statistics & numerical data Patients Prognosis Proportional Hazards Models Rehabilitation Retrospective Studies Review boards Stroke Volume - physiology Studies United States Variables Ventricular Dysfunction - mortality Ventricular Dysfunction - physiopathology |
| title | Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population |
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