scholarly journals Effect of cardiologist care on 6-month outcomes in patients discharged with heart failure: results from an observational study based on administrative data

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018243 ◽  
Author(s):  
Vera Maria Avaldi ◽  
Jacopo Lenzi ◽  
Stefano Urbinati ◽  
Dario Molinazzi ◽  
Carlo Descovich ◽  
...  
Keyword(s):  
Heart Failure ◽  
Observational Study ◽  
Administrative Data ◽  
Hospital Readmission ◽  
Patient Adherence ◽  
Angiotensin Receptor Blockers ◽  
Secondary Outcome ◽  
Evidence Based ◽  
Aldosterone Antagonists ◽  
Β Blockers

ObjectivesTo evaluate the effect of cardiologist care on adherence to evidence-based secondary prevention medications, mortality and readmission within 6 months of discharge in patients with heart failure (HF).DesignRetrospective observational study based on administrative data.SettingLocal Healthcare Authority (LHA) of Bologna, one of the largest LHAs of Italy with ~870 000 inhabitants.ParticipantsAll patients residing in the LHA of Bologna discharged from hospital with a diagnosis of HF between 1 January 2015 and 31 December 2015.Primary and secondary outcome measuresMultivariable regression analysis was used to assess the association of inpatient and outpatient cardiologist care with adherence to evidence-based medications, all-cause mortality and hospital readmission (including emergency room visits) within 6 months of discharge.ResultsThe study population included 2650 patients (mean age 82.3 years). 340 (12.8%) patients were discharged from cardiology wards, while 635 (24.0%) were seen by a cardiologist during follow-up. Inpatient and outpatient cardiologist care was associated with an increased likelihood of adherence to ACE inhibitors/angiotensin receptor blockers (ACEIs/ARBs), β-blockers and aldosterone antagonists after discharge. The risk of mortality was significantly lower among patients adherent to ACEIs/ARBs and/or β-blockers (–53% and –28%, respectively); the risk of hospital readmission was significantly lower among patients adherent to ACEIs/ARBs (–28%).ConclusionsCompared with non-specialist care, cardiologist care improves patient adherence to evidence-based medications and might thus favourably affect mortality and readmission following HF.

Abstract P386: Pre-hospitalization Medication Use in Black and White Medicare Beneficiaries Hospitalized With Heart Failure

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Emily B Levitan ◽  
Melissa K Van Dyke ◽  
Ligong Chen ◽  
Meredith L Kilgore ◽  
Todd M Brown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ace Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Systolic Dysfunction ◽  
Medication Use ◽  
Medicare Beneficiaries ◽  
Aldosterone Antagonists ◽  
Black And White ◽  
Blacks And Whites ◽  
Β Blockers

Background: Guidelines for treatment of heart failure (HF) with reduced ejection fraction recommend use of β-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), aldosterone antagonists, diuretics, digoxin, and, for blacks, the combination of hydralazine and isosorbide dinitrate. Race-specific treatment guidelines, differences in pathophysiology, comorbidities, and contraindications, and patient and provider preferences may result in differential use of these medications in blacks and whites with HF. Objectives: To examine differences in pre-hospitalization medication use among black and white Medicare beneficiaries hospitalized for HF. Methods: Medicare beneficiaries with fee-for-service and pharmacy coverage who had HF hospitalizations (inpatient claims for ≥1 overnight stay with HF as the primary discharge diagnosis, discharged alive) between 2007 and 2011 were identified in the Medicare national 5% sample. More than 98% of Medicare beneficiaries hospitalized for HF had prior inpatient or outpatient diagnoses of HF. Characteristics and medication use in the year prior to hospitalization were assessed through Medicare data. We compared pre-hospitalization medication use between black and white beneficiaries in the overall population with HF (n = 42,721) and in the subpopulation with documented systolic dysfunction (n = 9,702) with a χ 2 test. Results: Use of β-blockers and aldosterone antagonist was similar between blacks and whites ( Table ). Blacks were more likely to use ACE inhibitors, ARBs, and hydralazine. Whites were more likely to use diuretics and digoxin. Results were consistent when the population was limited to those with documented systolic dysfunction. Conclusions: Blacks were as likely as or more likely than whites to receive pharmacologic heart failure therapies with the exception of diuretics, which were none the less commonly used, and digoxin. Additional research is needed to determine the causes and implications of these differences.

scholarly journals The Management of Heart Failure with Preserved Ejection Fraction

2015 ◽  
Vol 1 (1) ◽  
pp. 11 ◽  
Author(s):  
Andrew JS Coats ◽  
Louise G Shewan ◽  
◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Left Ventricular ◽  
Clinical Syndrome ◽  
Aldosterone Antagonists ◽  
Sharp Separation ◽  
Clinical Trial Evidence ◽  
Receptor Blockers

Heart failure is defined as a clinical syndrome and is known to present with a number of different pathophysiological patterns. There is a remarkable degree of variation in measures of left ventricular systolic emptying and this has been used to categorise heart failure into two separate types: low ejection fraction (EF) heart failure or HF-REF and high EF heart failure or HF-PEF. Here we review the pathophysiology, epidemiology and management of HF-PEF and argue that sharp separation of heart failure into two forms is misguided and illogical, and the present scarcity of clinical trial evidence for effective treatment for HF-PEF is a problem of our own making; we should never have excluded patients from major trials on the basis of EF in the first place. Whilst as many heart failure patients have preserved EFs as reduced we have dramatically under-represented HF-PEF patients in trials. Only four trials have been performed in HF-PEF specifically, and another two trials that recruited both HF-PEF and HF-REF can be considered. When we consider the similarity in outcomes and neurohormonal activation between HF-REF and HF-REF, the vast corpus of trial data that we have to attest to the efficacy of various treatment (angiotensinconverting-enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], beta-blockers and aldosterone antagonists) in HF-REF, and the much more limited number of trials of similar agents showing near statistically significant benefits in HF-PEF the time has come rethink our management of HF-PEF, and in particular our selection of patients for trials.

P1664Pharmacological treatment patterns in heart failure: a real world cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Bosco-Levy ◽  
C Favary ◽  
J Jove ◽  
R Lassalle ◽  
N Moore ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Real World ◽  
Drug Exposure ◽  
Angiotensin Receptor Blockers ◽  
Treatment Patterns ◽  
First Year ◽  
Combination Drug ◽  
Aldosterone Antagonists

Abstract Background Although the efficacy and safety of existing therapies of heart failure (HF) have been demonstrated in clinical trials in the last 35 years, little is known about the treatment patterns of HF in clinical practice, especially in France. Objectives To describe the treatment initiation patterns and the subsequent treatment changes among HF patients, in the first year following an incident hospitalisation for HF, in a French real-world setting. Methods A cohort of patients aged 40 years old and older, with an incident hospitalisation for HF between January 1, 2008 and December 31, 2013, was identified in the EGB, a 1/97 permanent random sample of the French nationwide claims database. All patients who died during the index hospitalization or with a period of at least 3 consecutive months with no healthcare dispensing recorded were excluded. All included patients were followed one year. HF drugs of interest were: beta blockers (BB), angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), aldosterone antagonists (AA), diuretics, digoxin or ivabradine. Drug exposure was assessed quarterly using a Proportion of Days Covered >66% (>60 days out of the 90 days of the quarter covered by the treatment of interest), by considering HF drugs individually or in combination. Drug changes were assessed between each quarter over the first year of follow-up. Results Between 2008 and 2013, 7,387 from the EGB were included in the cohort study. The mean age at baseline was 77.7 years (±12.0 years) and 51.6% were women. During the follow-up, 24.4% of patients died and 20% did not receive any HF treatment. During the first quarter following initial hospitalisation, 42.7% of patients had diuretics, 26.0% had BB, 25.7% had ACEI, 7.4% had ARB, 7.6% had AA, 4.7% had digoxin and 1.3% had ivabradine. the most frequent combination was BB/ACE/ARB (23.4%). These proportions remained globally constant in each quarter of the follow-up. The main change occurred between thee first and the second quarter and concerned 53.1% of the initially untreated patients; by the second quarter, 22.2% of them initiated a BB/ACI/ARB combination, 13% a diuretic alone, 7.4% a BB and 4.9% a BB/ACI/ARB/AA combination. Conclusion This study provides precious information on treatment patterns after an initial hospital admission for HF at a time when new treatments for HF are emerging. Acknowledgement/Funding None

Abstract 14370: Rapidly Improving Adherence to Guideline-Directed Medical Therapies in Metropolitan Heart Failure Systems of Care

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jacqueline Tomei ◽  
Robin Y Kiser ◽  
Lynn Mallas-Serdynski ◽  
Michelle Scharnott ◽  
Michele M Bolles ◽  
...  
Keyword(s):  
Heart Failure ◽  
Patient Outcomes ◽  
Professional Education ◽  
Systems Of Care ◽  
Beta Blockers ◽  
Primary Diagnosis ◽  
Evidence Based ◽  
Aldosterone Antagonists ◽  
Aldosterone Antagonist ◽  
The Mean

Background: The 2017 AHA/ACC/HFSA Focused Update of the 2013 ACC/AHA Guidelines for the Management of Heart Failure provided additional support for the clinical use of ACEI, ARBs or ARNIs in conjunction with Evidence-Based Beta Blockers and Aldosterone Antagonists in HFrEF, otherwise known as Guideline-Directed Medical Therapy (GDMT). Although these updates clarified the benefits of GDMT to patient outcomes, low rates of adherence at the provider level for both hospitalized and ambulatory patients continue to be seen. Methods: With the objective of rapidly improving GDMT utilization, as well as improving patient outcomes, the American Heart Association initiated a multidisciplinary collaborative in three metropolitan markets - Chicago, Milwaukee, and St. Louis. Utilizing Get With The Guidelines®-Heart Failure (GWTG-HF), 40 hospitals tracked patients discharged with a primary diagnosis of heart failure and entered data from their inpatient and 30-days post-acute record. An initiative benchmark group was created to track progress and revisions were made to the post-acute care form. Hospitals were provided targeted consultation using hospital-specific data compared to regional and initiative benchmarks. The initiative provided exclusive professional education, including webinars, collaboration meetings, and best-practice recommendations. Results: Between January 1, 2019 and December 31, 2019, 10,532 patients with a primary diagnosis of heart failure, were entered into GWTG-HF from the 40 initiative hospitals, in which 3807 had an EF of <40%. A comparison from Q1 to Q4, 2019 of the mean adherence for GDMT was performed at discharge and yielded the following results: ACEI/ARB or ARNi from 89.3% to 91.6%, Evidenced-Based Beta Blockers from 90.3% to 94.2% and Aldosterone Antagonist from 53.6% to 64.7%; At 30-Days the mean adherence for Q1 and Q4 were calculated as follows: ACEI/ARB or ARNi from 60.4% to 72.9% and Aldosterone Antagonist from 28.2% to 55.3%. Evidence-Based Beta Blocker was only captured for Q3 and Q4, 2019 and the mean adherence improved from 70.3% to 73.8%. Conclusions: The multi-city quality initiative early results show a positive correlation in improving adherence to GDMT in both the hospital and ambulatory setting.

Medication Use in Women and Men With Sudden Unexpected Death

2018 ◽  
Vol 52 (9) ◽  
pp. 868-875 ◽  
Author(s):  
Sonalie Patel ◽  
Mitchell M. Conover ◽  
Golsa Joodi ◽  
Sarah Chen ◽  
Ross J. Simpson ◽  
...  
Keyword(s):  
Sudden Death ◽  
Anatomical Therapeutic Chemical ◽  
Angiotensin Receptor Blockers ◽  
Sudden Unexpected Death ◽  
Medical Examiner ◽  
Evidence Based ◽  
Unexpected Death ◽  
Converting Enzyme Inhibitors ◽  
Β Blockers ◽  
Wake County

Background: In Wake County, NC, sudden unexpected death accounts for 10% to 15% of all natural deaths in individuals 18 to 64 years old. Medications such as aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, and β-blockers are recommended in guidelines to reduce cardiovascular events and even sudden death (β-blockers). However, guidelines are often underpracticed, even in high-risk patients, with noted disparities in women. Objective: We assessed the relation between prescription of evidence-based medications and sudden unexpected death in Wake County, NC. Methods: We analyzed 399 cases of sudden unexpected death for the time period March 1, 2013 to February 28, 2015 in Wake County, NC. Medications were assessed from available medical examiner reports and medical records and grouped using the third level of the Anatomical Therapeutic Chemical Classification System (ATC) codes. This study was reviewed and exempt by the University of North Carolina’s institutional review board. Results: Among 126 female and 273 male victims, women were prescribed more medications overall than men (6.5 vs 4.3, P = 0.001); however, the use of guideline-directed therapies was not different between genders in the chronic conditions associated with sudden death. Overall, there was remarkably low use of evidence-based medications. Conclusions: Our findings highlight the need to improve prescribing of evidence-based medications and to further explore the relationship between undertreatment and sudden unexpected death.

scholarly journals Aldosterone Antagonists: Evidence-Based Yet Underutilized Effective Heart Failure Therapy

2013 ◽  
Vol 19 (3) ◽  
pp. 105-106 ◽  
Author(s):  
Carl J. Lavie ◽  
James J. DiNicolantonio ◽  
James H. O'Keefe ◽  
Hector O. Ventura
Keyword(s):  
Heart Failure ◽  
Evidence Based ◽  
Heart Failure Therapy ◽  
Aldosterone Antagonists

scholarly journals In-hospital myocardial infarction and adherence to evidence-based drug therapies: a real-world evaluation

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042878
Author(s):  
Salvatore Soldati ◽  
Mirko Di Martino ◽  
Davide Castagno ◽  
Marina Davoli ◽  
Danilo Fusco
Keyword(s):  
Myocardial Infarction ◽  
Angiotensin Receptor Blockers ◽  
Medication Possession Ratio ◽  
Poor Adherence ◽  
Secondary Outcome ◽  
Medical Attention ◽  
Evidence Based ◽  
Lazio Region ◽  
Hospitalised Patients

ObjectivesThis study aimed to measure adherence to chronic polytherapy following an acute myocardial infarction (AMI) and to find out associations between adherence and the setting of AMI onset (in vs out of hospital) as well as other determinants.DesignRetrospective follow-up study.SettingPopulation living in the Lazio Region, Italy.ParticipantsThis study included 25 779 hospitalised patients with a first diagnosis of AMI in 2012–2016, after the exclusion of those with hospital admission for AMI or related causes in the previous 5 years.Primary and secondary outcome measuresPatients were classified as in-hospital AMI (IH-AMI) or out of hospital AMI (OH-AMI) according to present-on-admission codes. Adherence was measured based on prescription claims during a 6-month follow-up after hospital discharge, using medication possession ratio (MPR). Adherence to chronic polytherapy was defined as MPR ≥75% to at least 3 of the following medications: antithrombotics, betablockers, ACE inhibitors/angiotensin receptor blockers and statins.ResultsAmong the entire cohort, 1 044 (4%) patients suffered IH-AMI. Overall, 15 440 (60%) patients were deemed adherent to chronic polytherapy. Female gender, older age, mental disorders, renal disease, asthma and ongoing concomitant treatments were factors associated with poor adherence. By contrast, patients with more severe AMI and those already taking evidence-based (E-B) drugs were more likely to be adherent. A strong association between the setting of AMI onset and adherence was observed: IH-AMI patients were 46% less likely to be adherent to E-B medications during their 6-month follow-up as compared with OH-AMI patients (OR 0.54; 95% CI 0.47 to 0.62; p<0.001).ConclusionPharmacotherapy is not consistent with clinical guidelines, especially for IH-AMI patients. Our findings provide evidence on a previously unidentified groups of patients at risk for poor adherence, who might benefit from greater medical attention and dedicated healthcare interventions.

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