scholarly journals Resource utilization and costs among patients with heart failure with reduced ejection fraction following a worsening heart failure event

2021 ◽  
Author(s):  
Michael M. Givertz ◽  
Mei Yang ◽  
Gregory P. Hess ◽  
Bin Zhao ◽  
Ashwin Rai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Resource Utilization ◽  
Reduced Ejection Fraction ◽  
Heart Failure Event ◽  
Patients With Heart Failure ◽  
Failure Event

scholarly journals BAROREFLEX ACTIVATION THERAPY REDUCES HOSPITAL RESOURCE UTILIZATION IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION

2014 ◽  
Vol 63 (12) ◽  
pp. A923 ◽  
Author(s):  
Edoardo Gronda ◽  
Giuseppe Costantino ◽  
Tiziana Staine ◽  
Andrea Moneta ◽  
ndrea Casini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Resource Utilization ◽  
Hospital Resource ◽  
Baroreflex Activation Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Activation Therapy

scholarly journals Characteristics and Outcomes of Patients With Heart Failure With Reduced Ejection Fraction After a Recent Worsening Heart Failure Event

2021 ◽  
Author(s):  
Anthony P. Carnicelli ◽  
Robert Clare ◽  
Paul Hofmann ◽  
Karen Chiswell ◽  
Adam D. DeVore ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Hazard Ratio ◽  
Tertiary Referral Center ◽  
Reduced Ejection Fraction ◽  
Large Subgroup ◽  
Patients With Heart Failure ◽  
Failure Event ◽  
Duke University ◽  
Lower Ejection Fraction

Background Contemporary trials of patients with heart failure with reduced ejection fraction (HFrEF) required a recent worsening heart failure (WHF) event for inclusion. We aimed to describe characteristics and outcomes of patients with HFrEF and a recent WHF event at a large tertiary referral center. Methods and Results We identified adult patients with chronic symptomatic HFrEF (ejection fraction ≤35%) treated at Duke University between January 1, 2009, and December 31, 2018, and applied a set of exclusion criteria to generate a cohort similar to those enrolled in contemporary heart failure trials. Patients were stratified by presence or absence of a recent WHF event, defined as an emergency department visit for heart failure or hospitalization for heart failure in the prior 12 months. Characteristics and outcomes including death and hospitalization were assessed. Of 3867 patients with HFrEF meeting study criteria, 2823 (73.0%) had a WHF event in the prior 12 months. Compared with patients without a WHF event, those with a WHF event were more likely to be under‐represented racial and ethnic groups and had lower ejection fraction, a greater burden of comorbidities, and more echocardiographic evidence of cardiac dysfunction. Despite higher use of guideline‐directed therapies, patients with a WHF event had higher rates of death (hazard ratio, 2.30; 95% CI, 2.01–2.63), all‐cause hospitalization (hazard ratio, 1.56; 95% CI, 1.42–1.71), and heart failure hospitalization (hazard ratio, 1.59; 95% CI, 1.44–1.75) through 5 years compared with those without a recent WHF event. Conclusions WHF events are common in patients with HFrEF and are associated with more advanced disease. Patients with recent WHF have high rates of death and hospitalization, underscoring the need for novel therapies in this large subgroup of patients with HFrEF.

Diuretic Changes, Health Care Resource Utilization, and Clinical Outcomes for Heart Failure With Reduced Ejection Fraction: From the Change the Management of Patients With Heart Failure Registry

2021 ◽  
Author(s):  
Muhammad Shahzeb Khan ◽  
Stephen J. Greene ◽  
Anne S. Hellkamp ◽  
Adam D. DeVore ◽  
Xian Shen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Resource Utilization ◽  
Rate Ratio ◽  
Total Daily Dose ◽  
Dose Increase ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Background: Diuretics are a mainstay therapy for the symptomatic treatment of heart failure. However, in contemporary US outpatient practice, the degree to which diuretic dosing changes over time and the associations with clinical outcomes and health care resource utilization are unknown. Methods: Among 3426 US outpatients with chronic heart failure with reduced ejection fraction in the Change the Management of Patients with Heart Failure registry with complete medication data and who were prescribed a loop diuretic, diuretic dose increase was defined as: (1) change to a total daily dose higher than their previous total daily dose, (2) addition of metolazone to the regimen, (3) change from furosemide to either bumetanide or torsemide, and the change persists for at least 7 days. Adjusted hazard ratios or rate ratios along with 95% CIs were reported for clinical outcomes among patients with an increase in oral diuretic dose versus no increase in diuretic dose. Results: Overall, 796 (23%) had a diuretic dose increase (18 episodes per 100 patient-years). The proportion of patients with dyspnea at rest (38% versus 26%), dyspnea at exertion (79% versus 67%), orthopnea (32% versus 21%), edema (60% versus 43%), and weight gain (40% versus 23%) were significantly (all P <0.001) higher in the diuretic increase group. Baseline angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (hazard ratio, 0.75 [95% CI, 0.65–0.87]) use were associated with lower likelihood of diuretic increase over time. Patients with a diuretic dose increase had a significantly higher number of heart failure hospitalizations (rate ratio, 2.53 [95% CI, 2.10–3.05]), emergency department visits (rate ratio, 1.84 [95% CI, 1.56–2.17]), and home health visits (rate ratio, 1.88 [95% CI, 1.39–2.54]), but not all-cause mortality (hazard ratio, 1.10 [95% CI, 0.89–1.36]). Similarly, greater furosemide dose equivalent increases were associated with greater resource utilization but not with mortality, compared with smaller increases. Conclusions: In this contemporary US registry, 1 in 4 patients with heart failure with reduced ejection fraction had outpatient escalation of diuretic therapy over longitudinal follow-up, and these patients were more likely to have sign/symptoms of congestion. Outpatient diuretic dose escalation of any magnitude was associated with heart failure hospitalizations and resource utilization, but not all-cause mortality.

scholarly journals Clinical and Economic Burden of Chronic Heart Failure and Reduced Ejection Fraction Following a Worsening Heart Failure Event

2020 ◽  
Vol 37 (9) ◽  
pp. 4015-4032 ◽  
Author(s):  
Javed Butler ◽  
Laurence M. Djatche ◽  
Baanie Sawhney ◽  
Sreya Chakladar ◽  
Lingfeng Yang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Economic Burden ◽  
Reduced Ejection Fraction ◽  
Heart Failure Event ◽  
Failure Event

scholarly journals Dapagliflozin and Diuretic Use in Patients With Heart Failure and Reduced Ejection Fraction in DAPA-HF

Circulation ◽  
2020 ◽  
Vol 142 (11) ◽  
pp. 1040-1054 ◽  
Author(s):  
Alice M. Jackson ◽  
Pooja Dewan ◽  
Inder S. Anand ◽  
Jan Bělohlávek ◽  
Olof Bengtsson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diuretic Therapy ◽  
Cardiovascular Death ◽  
Adverse Outcomes ◽  
Unique Identifier ◽  
Reduced Ejection Fraction ◽  
End Point ◽  
Patients With Heart Failure ◽  
Failure Event

Background: In the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure), the sodium-glucose cotransporter 2 inhibitor dapagliflozin reduced the risk of worsening heart failure and death in patients with heart failure and reduced ejection fraction. We examined the efficacy and tolerability of dapagliflozin in relation to background diuretic treatment and change in diuretic therapy after randomization to dapagliflozin or placebo. Methods: We examined the effects of study treatment in the following subgroups: no diuretic and diuretic dose equivalent to furosemide <40, 40, and >40 mg daily at baseline. We examined the primary composite end point of cardiovascular death or a worsening heart failure event and its components, all-cause death and symptoms. Results: Of 4616 analyzable patients, 736 (15.9%) were on no diuretic, 1311 (28.4%) were on <40 mg, 1365 (29.6%) were on 40 mg, and 1204 (26.1%) were taking >40 mg. Compared with placebo, dapagliflozin reduced the risk of the primary end point across each of these subgroups: hazard ratios were 0.57 (95% CI, 0.36–0.92), 0.83 (95% CI, 0.63–1.10), 0.77 (95% CI, 0.60–0.99), and 0.78 (95% CI, 0.63–0.97), respectively ( P for interaction=0.61). The hazard ratio in patients taking any diuretic was 0.78 (95% CI, 0.68–0.90). Improvements in symptoms and treatment toleration were consistent across the diuretic subgroups. Diuretic dose did not change in most patients during follow-up, and mean diuretic dose did not differ between the dapagliflozin and placebo groups after randomization. Conclusions: The efficacy and safety of dapagliflozin were consistent across the diuretic subgroups examined in DAPA-HF. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03036124.

Comparison of Risk of Re-hospitalization, All-Cause Mortality, and Medical Care Resource Utilization in Patients With Heart Failure and Preserved Versus Reduced Ejection Fraction

2015 ◽  
Vol 116 (7) ◽  
pp. 1088-1092 ◽  
Author(s):  
Gregory A. Nichols ◽  
Kristi Reynolds ◽  
Teresa M. Kimes ◽  
A. Gabriela Rosales ◽  
Wing W. Chan
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Care ◽  
Resource Utilization ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality
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