TY - JOUR
T1 - Impact of left ventricular ejection fraction phenotypes on healthcare-resource utilization in hospitalized heart failure
T2 - A secondary analysis of REPORT-HF
AU - Farmakis, Dimitrios
AU - Tromp, Jasper
AU - Marinaki, Smaragdi
AU - Ouwerkerk, Wouter
AU - Angermann, Christiane E
AU - Bistola, Vasiliki
AU - Dahlstrom, Ulf
AU - Dickstein, Kenneth
AU - Ertl, Georg
AU - Ghadanfar, Mathieu
AU - Hassanein, Mahmoud
AU - Obergfell, Achim
AU - Perrone, Sergio V
AU - Polyzogopoulou, Eftihia
AU - Schweizer, Anja
AU - Boletis, Ioannis
AU - Cleland, John Gf
AU - Collins, Sean P
AU - Lam, Carolyn Sp
AU - FIlippatos, Gerasimos
N1 - Funding Information: This study was funded by Novartis Pharma AG. Role of the Funder/Sponsor: Novartis Pharma AG sponsored REPORT‐HF. The steering committee was responsible for the trial design, and supervised patient recruitment and clinical management of the trial. The sponsor curated the data and conducted descriptive analyses. They subsequently made a limited data set available to the authors to facilitate the statistical modeling at Vanderbilt University Medical Center. The steering committee oversaw analysis and interpretation of the data; preparation, review, and approval of the manuscript; and the decision to submit the manuscript for publication. The sponsor could comment on the manuscript before submission, but all final decisions were made by the authors. Publisher Copyright: © 2023 European Society of Cardiology.
PY - 2023/6
Y1 - 2023/6
N2 - Aim: Evidence on healthcare resource utilization (HCRU) for hospitalized patients with heart failure (HF) and reduced (HFrEF), mildly reduced (HFmrEF) and preserved (HFpEF) ejection fraction is limited. Methods and results: We analysed HCRU in relation to left ventricular ejection fraction (LVEF) phenotypes, clinical features and in-hospital and 12-month outcomes in 16 943 patients hospitalized for HF in a worldwide registry. HFrEF was more prevalent (53%) than HFmrEF (17%) or HFpEF (30%). Patients with HFmrEF and HFpEF were older, more often women, with milder symptoms and more comorbidities, but differences were not pronounced. HCRU was high in all three groups; two or more in- and out-of-hospital services were required by 51%, 49% and 52% of patients with HFrEF, HFmrEF and HFpEF, respectively, and intensive care unit by 41%, 41% and 37%, respectively. Hospitalization length was similar (median, 8 days). Discharge prescription of neurohormonal inhibitors was <80% for each agent in HFrEF and only slightly lower in HFmrEF and HFpEF (74% and 67%, respectively, for beta-blockers). Compared to HFrEF, 12-month all-cause and cardiovascular mortality were lower for HFmrEF (adjusted hazard ratios 0.78 [95% confidence interval 0.59–0.71] and 0.80 [0.70–0.92]) and HFpEF (0.64 [0.59–0.87] and 0.63 [0.56–0.71]); 12-month HF hospitalization was also lower for HFpEF and HFmrEF (21% and 20% vs. 25% for HFrEF). In-hospital mortality, 12-month non-cardiovascular mortality and 12-month all-cause hospitalization were similar among groups. Conclusions: In patients hospitalized for HF, overall HCRU was similarly high across LVEF spectrum, reflecting the subtle clinical differences among LVEF phenotypes during hospitalization. Discharge prescription of neurohormonal inhibitors was suboptimal in HFrEF and lower but significant in patients with HFpEF and HFmrEF, who had better long-term cardiovascular outcomes than HFrEF, but similar risk for non-cardiovascular events.
AB - Aim: Evidence on healthcare resource utilization (HCRU) for hospitalized patients with heart failure (HF) and reduced (HFrEF), mildly reduced (HFmrEF) and preserved (HFpEF) ejection fraction is limited. Methods and results: We analysed HCRU in relation to left ventricular ejection fraction (LVEF) phenotypes, clinical features and in-hospital and 12-month outcomes in 16 943 patients hospitalized for HF in a worldwide registry. HFrEF was more prevalent (53%) than HFmrEF (17%) or HFpEF (30%). Patients with HFmrEF and HFpEF were older, more often women, with milder symptoms and more comorbidities, but differences were not pronounced. HCRU was high in all three groups; two or more in- and out-of-hospital services were required by 51%, 49% and 52% of patients with HFrEF, HFmrEF and HFpEF, respectively, and intensive care unit by 41%, 41% and 37%, respectively. Hospitalization length was similar (median, 8 days). Discharge prescription of neurohormonal inhibitors was <80% for each agent in HFrEF and only slightly lower in HFmrEF and HFpEF (74% and 67%, respectively, for beta-blockers). Compared to HFrEF, 12-month all-cause and cardiovascular mortality were lower for HFmrEF (adjusted hazard ratios 0.78 [95% confidence interval 0.59–0.71] and 0.80 [0.70–0.92]) and HFpEF (0.64 [0.59–0.87] and 0.63 [0.56–0.71]); 12-month HF hospitalization was also lower for HFpEF and HFmrEF (21% and 20% vs. 25% for HFrEF). In-hospital mortality, 12-month non-cardiovascular mortality and 12-month all-cause hospitalization were similar among groups. Conclusions: In patients hospitalized for HF, overall HCRU was similarly high across LVEF spectrum, reflecting the subtle clinical differences among LVEF phenotypes during hospitalization. Discharge prescription of neurohormonal inhibitors was suboptimal in HFrEF and lower but significant in patients with HFpEF and HFmrEF, who had better long-term cardiovascular outcomes than HFrEF, but similar risk for non-cardiovascular events.
KW - Heart failure
KW - Heart failure hospitalization
KW - Left ventricular ejection fraction
KW - Mortality
KW - Pharmacotherapy
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85152785140&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ejhf.2833
DO - https://doi.org/10.1002/ejhf.2833
M3 - Article
C2 - 36974770
SN - 1388-9842
VL - 25
SP - 818
EP - 828
JO - European journal of heart failure
JF - European journal of heart failure
IS - 6
ER -