Background:
One of the primary goals of treatment for HFrEF is to improve patients’ health status; their symptoms, function, and quality of life, which has even been proposed as a performance measure for quality. We examined whether physician-led changes in HFrEF medications improved patients’ health status to highlight the opportunity for clinicians to improve patients’ health status.
Objectives:
To describe the association between changes in patients’ medical regimens with change in the health status of outpatients with heart failure and reduced ejection fraction (HFrEF).
Methods:
Using a multi-center, observational outpatient registry of patients with HFrEF, we examined the association of any change in HFrEF medications with 3-month change in health status, as measured by the 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Scale (KCCQ-OS). Unadjusted and multivariable-adjusted (25 clinical characteristics, baseline health status) results were obtained using hierarchical linear regression models.
Results:
Among 3,313 outpatients with HFrEF from 140 centers, 21.9% had a change in their HFrEF medications during routine clinical care. At 3 months, 23.7% and 46.4% experienced clinically meaningfully worse (≥ 5-point decrease) and improved (≥ 5-point increase) KCCQ-OS scores. The 3-month median change in KCCQ-OS for patients whose HFrEF medical regimen was changed was significantly larger (7.3 points [IQR: −3.1, 20.8]) than for patients whose medications were not changed (3.1 points [IQR:−4.7, 12.5], adjusted difference = 3.0 points (95% CI: 1.4, 4.6; p<0.001)). The proportion with a very large clinical improvement (≥20 points) was 26% in those whose medications were adjusted, vs. 14% when they were not.
Conclusions:
In routine care of patients with HFrEF, changes in HFrEF medications were associated with significant improvements in patients’ health status. Health status-based performance measures can quantify the benefits of titrating medicines in HFrEF patients.
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Aims Improving the health status (symptoms, function, and quality of life) of patients with heart failure with reduced ejection fraction (HFrEF) is a primary treatment goal. Angiotensin receptor neprilysin inhibitors (ARNI) improve short-term health status in clinical practice, but the sustainability of these improvements is unknown.
Methods and resultsIn CHAMP-HF, a multicentre observational study of outpatients with HFrEF, patients initiated on ARNI were propensity score matched 1:2 to patients not using ARNI with Cox regression modelling time to ARNI initiation, adjusted for sociodemographic and clinical variables, medical history, medications, and baseline Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. Repeated measures models for the overall KCCQ score and each domain compared the health status trajectories of patients initiated on ARNI vs. not. Among 3930 participants, 746 (19.0%) began ARNI, of whom 576 were matched to 1152 non-ARNI patients. Prior to matching, participants initiated on ARNI were younger, non-Hispanic, had lower EFs, more commonly had a history of ventricular arrhythmia, were less likely to be taking an ACEI/ARB, and more likely to be treated with beta-blockers and mineralocorticoid receptor antagonists. There were no differences after matching. In the matched cohort, participants initiated on ARNI experienced improved health status by 3 months that persisted through 12 months [KCCQ Overall Summary Score (OSS) = 73.4 vs. 70.8; P < 0.001], with the largest benefit observed in the KCCQ Quality of Life domain (68.7 vs. 64.7; P < 0.001). Similar health status benefits were noted through 18 months (KCCQ-OSS = 73.9 vs. 71.3; P < 0.001). A responder analysis showed that 12 patients would need to be initiated on ARNI for one to experience at least a large improvement (≥10 points) in health status benefit at 12 months. Conclusions In outpatient practice, ARNI therapy was associated with improved health status by 3 months and continued to 18 months after initiating therapy.
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