Language
English
Publication Date
10-1-2023
Journal
JACC: Heart Failure
DOI
10.1016/j.jchf.2023.04.017
PMID
37354145
Abstract
Background: There are few contemporary data on outcomes, costs, and treatment following a hospitalization for heart failure (hHF) in epidemiologically representative cohorts.
Objectives: This study sought to describe rehospitalizations, hospitalization costs, use of guideline-directed medical therapy (GDMT) (renin-angiotensin system inhibitors, sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors), and mortality after hHF.
Methods: EVOLUTION HF (Utilization of Dapagliflozin and Other Guideline Directed Medical Therapies in Heart Failure Patients: A Multinational Observational Study Based on Secondary Data) is an observational, longitudinal cohort study using data from electronic health records or claims data sources in Japan, Sweden, the United Kingdom, and the United States. Adults with a first hHF discharge between 2018 and 2022 were included. The 1-year event rates per 100 patient-years (ERs) for death and rehospitalizations (with a primary diagnosis of heart failure (HF), chronic kidney disease [CKD], myocardial infarction, stroke, or peripheral artery disease) were calculated. Hospital health care costs were cumulatively summarized. Cumulative GDMT use was assessed using Kaplan-Meier estimates.
Results: Of 263,525 patients, 28% died within the first year post-hHF (ER: 28.4 [95% CI: 27.0-29.9]). Rehospitalizations were mainly driven by HF (ER: 13.6 [95% CI: 9.8-17.4]) and CKD (ER: 4.5 [95% CI: 3.6-5.3]), whereas the ERs for myocardial infarction, stroke, and peripheral artery disease were lower. Health care costs were predominantly driven by HF and CKD. Between 2020 and 2022, use of renin-angiotensin system inhibitors, sacubitril/valsartan, beta-blockers, and mineralocorticoid receptor antagonists changed little, whereas uptake of sodium-glucose cotransporter-2 inhibitors increased 2- to 7-fold.
Conclusions: Incident post-hHF rehospitalization risks and costs were high, and GDMT use changed little in the year following discharge, highlighting the need to consider earlier and greater implementation of GDMT to manage risks and reduce costs.
Keywords
Adult, Humans, United States, Heart Failure, Sodium-Glucose Transporter 2 Inhibitors, Longitudinal Studies, Mineralocorticoid Receptor Antagonists, Valsartan, Antihypertensive Agents, Hospitalization, Adrenergic beta-Antagonists, Stroke Volume, Angiotensin Receptor Antagonists, Myocardial Infarction, Stroke, Renal Insufficiency, Chronic, Peripheral Arterial Disease, Glucose, Sodium, guideline-directed medical therapy, guideline-recommended pharmacotherapy, health care cost, hospitalization for heart failure, incident heart failure, mortality
Published Open-Access
yes
Recommended Citation
Bozkurt, Biykem; Savarese, Gianluigi; Adamsson Eryd, Samuel; et al., "Mortality, Outcomes, Costs, and Use of Medicines Following a First Heart Failure Hospitalization: EVOLUTION HF" (2023). Faculty and Staff Publications. 4046.
https://digitalcommons.library.tmc.edu/baylor_docs/4046