Trends in the Use of Guideline-Directed Therapies Among Dialysis Patients Hospitalized With Systolic Heart Failure. Findings From the American Heart Association Get With The Guidelines-Heart Failure Program

Ambarish Pandey, Harsh Golwala, Adam D. DeVore, Di Lu, George Madden, Deepak L. Bhatt, Phillip Schulte, Paul A. Heidenreich, Clyde W. Yancy, Adrian F. Hernandez, Gregg C. Fonarow

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to determine the temporal trends in the adherence to heart failure (HF)-related process of care measures and clinical outcomes among patients with acute decompensated HF with reduced ejection fraction (HFrEF) and end-stage renal disease (ESRD). Background: Previous studies have demonstrated significant underuse of evidence-based HF therapies among patients with coexisting ESRD and HFrEF. However, it is unclear if the proportional use of evidence-based medical therapies and associated clinical outcomes among these patients has changed over time. Methods: Get With The Guidelines-HF study participants who were admitted for acute HFrEF between January 2005 and June 2014 were stratified into 3 groups on the basis of their admission renal function: normal renal function, renal insufficiency without dialysis, and dialysis. Temporal change in proportional adherence to the HF-related process of care measures and incidence of clinical outcomes (1-year mortality, HF hospitalization, and all-cause hospitalization) during the study period was evaluated across the 3 renal function groups. Results: The study included 111,846 patients with HFrEF from 390 participating centers, of whom 19% had renal insufficiency but who did not require dialysis, and 3% were on dialysis. There was a significant temporal increase in adherence to evidence-based medical therapies (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker: p trend <0.0001, β-blockers: p trend = 0.0089; post-discharge follow-up referral: p trend <0.0001) and defect-free composite care (p trend <0.0001) among dialysis patients. An improvement in adherence to these measures was also observed among patients with normal renal function and patients with renal insufficiency without a need for dialysis. There was no significant change in cumulative incidence of clinical outcomes over time among the HF patients on dialysis. Conclusions: In a large contemporary cohort of HFrEF patients with ESRD, adherence to the HF process of care measures has improved significantly over the past 10 years. Unlike patients with normal renal function, there was no significant change in 1-year clinical outcomes over time among HF patients on dialysis.

Original languageEnglish (US)
JournalJACC: Heart Failure
DOIs
StateAccepted/In press - Feb 3 2016
Externally publishedYes

Fingerprint

Systolic Heart Failure
Dialysis
Heart Failure
Guidelines
Process Assessment (Health Care)
Kidney
Therapeutics
Chronic Kidney Failure
Renal Insufficiency
Hospitalization
Angiotensin Receptor Antagonists
Incidence
Angiotensin-Converting Enzyme Inhibitors
Referral and Consultation

Keywords

  • Dialysis
  • Heart failure with reduced ejection fraction
  • Outcomes
  • Quality of care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Trends in the Use of Guideline-Directed Therapies Among Dialysis Patients Hospitalized With Systolic Heart Failure. Findings From the American Heart Association Get With The Guidelines-Heart Failure Program. / Pandey, Ambarish; Golwala, Harsh; DeVore, Adam D.; Lu, Di; Madden, George; Bhatt, Deepak L.; Schulte, Phillip; Heidenreich, Paul A.; Yancy, Clyde W.; Hernandez, Adrian F.; Fonarow, Gregg C.

In: JACC: Heart Failure, 03.02.2016.

Research output: Contribution to journalArticle

Pandey, Ambarish ; Golwala, Harsh ; DeVore, Adam D. ; Lu, Di ; Madden, George ; Bhatt, Deepak L. ; Schulte, Phillip ; Heidenreich, Paul A. ; Yancy, Clyde W. ; Hernandez, Adrian F. ; Fonarow, Gregg C. / Trends in the Use of Guideline-Directed Therapies Among Dialysis Patients Hospitalized With Systolic Heart Failure. Findings From the American Heart Association Get With The Guidelines-Heart Failure Program. In: JACC: Heart Failure. 2016.
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abstract = "Objectives: The purpose of this study was to determine the temporal trends in the adherence to heart failure (HF)-related process of care measures and clinical outcomes among patients with acute decompensated HF with reduced ejection fraction (HFrEF) and end-stage renal disease (ESRD). Background: Previous studies have demonstrated significant underuse of evidence-based HF therapies among patients with coexisting ESRD and HFrEF. However, it is unclear if the proportional use of evidence-based medical therapies and associated clinical outcomes among these patients has changed over time. Methods: Get With The Guidelines-HF study participants who were admitted for acute HFrEF between January 2005 and June 2014 were stratified into 3 groups on the basis of their admission renal function: normal renal function, renal insufficiency without dialysis, and dialysis. Temporal change in proportional adherence to the HF-related process of care measures and incidence of clinical outcomes (1-year mortality, HF hospitalization, and all-cause hospitalization) during the study period was evaluated across the 3 renal function groups. Results: The study included 111,846 patients with HFrEF from 390 participating centers, of whom 19{\%} had renal insufficiency but who did not require dialysis, and 3{\%} were on dialysis. There was a significant temporal increase in adherence to evidence-based medical therapies (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker: p trend <0.0001, β-blockers: p trend = 0.0089; post-discharge follow-up referral: p trend <0.0001) and defect-free composite care (p trend <0.0001) among dialysis patients. An improvement in adherence to these measures was also observed among patients with normal renal function and patients with renal insufficiency without a need for dialysis. There was no significant change in cumulative incidence of clinical outcomes over time among the HF patients on dialysis. Conclusions: In a large contemporary cohort of HFrEF patients with ESRD, adherence to the HF process of care measures has improved significantly over the past 10 years. Unlike patients with normal renal function, there was no significant change in 1-year clinical outcomes over time among HF patients on dialysis.",
keywords = "Dialysis, Heart failure with reduced ejection fraction, Outcomes, Quality of care",
author = "Ambarish Pandey and Harsh Golwala and DeVore, {Adam D.} and Di Lu and George Madden and Bhatt, {Deepak L.} and Phillip Schulte and Heidenreich, {Paul A.} and Yancy, {Clyde W.} and Hernandez, {Adrian F.} and Fonarow, {Gregg C.}",
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AU - Pandey, Ambarish

AU - Golwala, Harsh

AU - DeVore, Adam D.

AU - Lu, Di

AU - Madden, George

AU - Bhatt, Deepak L.

AU - Schulte, Phillip

AU - Heidenreich, Paul A.

AU - Yancy, Clyde W.

AU - Hernandez, Adrian F.

AU - Fonarow, Gregg C.

PY - 2016/2/3

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N2 - Objectives: The purpose of this study was to determine the temporal trends in the adherence to heart failure (HF)-related process of care measures and clinical outcomes among patients with acute decompensated HF with reduced ejection fraction (HFrEF) and end-stage renal disease (ESRD). Background: Previous studies have demonstrated significant underuse of evidence-based HF therapies among patients with coexisting ESRD and HFrEF. However, it is unclear if the proportional use of evidence-based medical therapies and associated clinical outcomes among these patients has changed over time. Methods: Get With The Guidelines-HF study participants who were admitted for acute HFrEF between January 2005 and June 2014 were stratified into 3 groups on the basis of their admission renal function: normal renal function, renal insufficiency without dialysis, and dialysis. Temporal change in proportional adherence to the HF-related process of care measures and incidence of clinical outcomes (1-year mortality, HF hospitalization, and all-cause hospitalization) during the study period was evaluated across the 3 renal function groups. Results: The study included 111,846 patients with HFrEF from 390 participating centers, of whom 19% had renal insufficiency but who did not require dialysis, and 3% were on dialysis. There was a significant temporal increase in adherence to evidence-based medical therapies (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker: p trend <0.0001, β-blockers: p trend = 0.0089; post-discharge follow-up referral: p trend <0.0001) and defect-free composite care (p trend <0.0001) among dialysis patients. An improvement in adherence to these measures was also observed among patients with normal renal function and patients with renal insufficiency without a need for dialysis. There was no significant change in cumulative incidence of clinical outcomes over time among the HF patients on dialysis. Conclusions: In a large contemporary cohort of HFrEF patients with ESRD, adherence to the HF process of care measures has improved significantly over the past 10 years. Unlike patients with normal renal function, there was no significant change in 1-year clinical outcomes over time among HF patients on dialysis.

AB - Objectives: The purpose of this study was to determine the temporal trends in the adherence to heart failure (HF)-related process of care measures and clinical outcomes among patients with acute decompensated HF with reduced ejection fraction (HFrEF) and end-stage renal disease (ESRD). Background: Previous studies have demonstrated significant underuse of evidence-based HF therapies among patients with coexisting ESRD and HFrEF. However, it is unclear if the proportional use of evidence-based medical therapies and associated clinical outcomes among these patients has changed over time. Methods: Get With The Guidelines-HF study participants who were admitted for acute HFrEF between January 2005 and June 2014 were stratified into 3 groups on the basis of their admission renal function: normal renal function, renal insufficiency without dialysis, and dialysis. Temporal change in proportional adherence to the HF-related process of care measures and incidence of clinical outcomes (1-year mortality, HF hospitalization, and all-cause hospitalization) during the study period was evaluated across the 3 renal function groups. Results: The study included 111,846 patients with HFrEF from 390 participating centers, of whom 19% had renal insufficiency but who did not require dialysis, and 3% were on dialysis. There was a significant temporal increase in adherence to evidence-based medical therapies (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker: p trend <0.0001, β-blockers: p trend = 0.0089; post-discharge follow-up referral: p trend <0.0001) and defect-free composite care (p trend <0.0001) among dialysis patients. An improvement in adherence to these measures was also observed among patients with normal renal function and patients with renal insufficiency without a need for dialysis. There was no significant change in cumulative incidence of clinical outcomes over time among the HF patients on dialysis. Conclusions: In a large contemporary cohort of HFrEF patients with ESRD, adherence to the HF process of care measures has improved significantly over the past 10 years. Unlike patients with normal renal function, there was no significant change in 1-year clinical outcomes over time among HF patients on dialysis.

KW - Dialysis

KW - Heart failure with reduced ejection fraction

KW - Outcomes

KW - Quality of care

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