Age- and sex-related differences in use of guideline-recommended care and mortality among patients with incident heart failure in Denmark

Nakano, Anne; Egstrup, Kenneth; Svendsen, Marie Louise; Schjødt, Inge; Jakobsen, Lars; Mehnert, Frank

doi:10.1093/ageing/afw119

Cited by 10 publications

(6 citation statements)

References 25 publications

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“…28,29 Further, there may be a dose-response association between the fulfilment of performance measures and mortality. 30 Our analyses revealed a gap in the quality of HF care provided by the Danish Healthcare system regardless of the causal mechanisms. We demonstrated that living alone was associated with a lower chance of receiving all HF care processes except treatment with MRA.…”

Section: Socioeconomic Factors and Composite Scores For Process Performance Measuresmentioning

confidence: 72%

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Inequalities in heart failure care in a tax‐financed universal healthcare system: a nationwide population‐based cohort study

et al. 2020

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Aims Data on socioeconomic-related differences in heart failure (HF) care are sparse. Inequality in care may potentially contribute to a poor clinical outcome. We examined socioeconomic-related differences in quality of HF care among patients with incident HF with reduced ejection fraction (EF) (HFrEF). Methods and results We conducted a nationwide population-based cohort study among patients with HFrEF (EF ≤40%) registered from January 2008 to October 2015 in the Danish Heart Failure Registry, a nationwide registry of patients with a first-time primary HF diagnosis. Associations between individual-level socioeconomic factors (cohabitation status, education, and family income) and the quality of HF care defined by six guideline-recommended process performance measures [New York Heart Association (NYHA) classification, treatment with angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), beta-blockers and mineralocorticoid receptor antagonists, exercise training, and patient education] were assessed using multiple imputation and multivariable logistic regression controlling for potential confounders. Among 17 122 HFrEF patients included, 15 290 patients had data on all six process performance measures. Living alone was associated with lower odds of NYHA classification [adjusted OR (aOR) 0.81; 95% confidence interval (CI): 0.72-0.90], prescription of ACEI/ARB (aOR 0.76; 95% CI: 0.68-0.88) and beta-blockers (aOR 0.84; 95% CI: 0.76-0.93), referral to exercise training (aOR 0.75; 95% CI: 0.69-0.81), and patient education (aOR 0.73; 95% CI: 0.67-0.80). Compared with high-level education, low-level education was associated with lower odds of NYHA classification (aOR 0.93; 95% CI: 0.79-1.11), treatment with ACEI/ARB (aOR 0.99; 95% CI: 0.81-1.20) and beta-blockers (aOR 0.93; 95% CI: 0.79-1.09), referral to exercise training (aOR 0.73; 95% CI: 0.65-0.82), and patient education (aOR 0.86, 95% CI: 0.75-0.98). An income in the lowest tertile was associated with lower odds of NYHA classification (aOR 0.67; 95% CI: 0.58-0.79), prescription of ACEI/ARB (aOR 0.80, 95% CI: 0.67-0.95) and beta-blockers (aOR 0.88, 95% CI: 0.86-1.01), referral to exercise training (aOR 0.59, 95% CI: 0.53-0.64), and patient education (aOR 0.66; 95% CI: 0.59-0.74) compared with an income in the highest tertile. Overall, no systematic differences were seen when the analyses were stratified by sex and age groups. Conclusions Living alone, low-level education, and income in the lowest tertile were associated with reduced use of recommended processes of HF care among Danish HFrEF patients with a first-time primary HF diagnosis. Efforts are warranted to ensure guideline-recommended HF care to all HFrEF patients, irrespective of socioeconomic background.

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Section: Socioeconomic Factors and Composite Scores For Process Performance Measuresmentioning

confidence: 72%

“…ACEI/ARB) and mortality and readmission among patients with HF, while other studies have not found this association 28,29 . Further, there may be a dose–response association between the fulfilment of performance measures and mortality 30 …”

Section: Discussionmentioning

confidence: 93%

Inequalities in heart failure care in a tax‐financed universal healthcare system: a nationwide population‐based cohort study

et al. 2020

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“…This study also demonstrates that HF is a disease of the elderly and does not exist in isolation [ 21 , 22 ]. There is some evidence that older patients with HF are less likely to receive guideline-recommended care [ 23 ]. However, most current HF guidelines globally are disease specific and the trials on which they are based often excluded patients with multimorbidity [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Heart Failure and Multimorbidity in Australian General Practice

et al. 2017

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BackgroundHeart failure (HF) is a serious condition that mostly affects older people. Despite the ageing population experiencing an increased prevalence of many chronic conditions, current guidelines focus on isolated management of HF.ObjectiveTo describe the burden of multimorbidity in patients with HF being managed in general practice in Australia.DesignData from the Bettering the Evaluation And Care of Health (BEACH) programme were used to determine (i) the prevalence of HF, (ii) the number of co-existing long-term conditions, and (iii) the most common disease combinations in patients with HF. The study was undertaken over fifteen, 5-week recording periods between November 2012 and March 2016.ResultsThe dataset included a total of 25,790 general practitioner (GP) encounters with patients aged ≥45 years, collected by 1,445 GPs. HF had been diagnosed in 1,119 of these patients, a prevalence of 4.34% (95% confidence interval [CI] 3.99–4.68) among patients at GP encounters, and 2.08% (95% CI 1.87–2.29) when applied to the general Australian population overall. HF rarely occurred in isolation, with 99.1% of patients having at least one and 53.4% having six or more other chronic illnesses. The most common pair of comorbidities among active patients with HF was hypertension and osteoarthritis (43.4%).ConclusionOverall, one in every 20–25 GP encounters with patients aged ≥45 years in Australia is with a patient with HF. Multimorbidity is a typical presentation among this patient group and guidelines for general practice must take this into account.

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“…Thus far, the trial population has been younger than in the real world; moreover, women have usually been underrepresented in all HF clinical trials. 5 , 6 Therefore, in this study, we studied how different levels of adherence to GDMT affect the risk of mortality in patients with HF across the LVEF spectrum in a real‐world clinical setting.…”

Section: Introductionmentioning

confidence: 99%

Impact of adherence to guideline‐directed therapy on risk of death in HF patients across an ejection fraction spectrum

Chen,

Kang,

Dahlström

et al. 2023

ESC Heart Failure

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AimsHow different degrees of adherence to guideline‐directed medical therapy (GDMT) affect mortality risk in patients with heart failure (HF) in a real‐world clinical setting is poorly understood. This study sought to investigate how different levels of adherence to GDMT were associated with the risk of all‐cause mortality in patients with HF across a spectrum of left ventricular ejection fractions (LVEFs) in a real‐world clinical setting.Methods and resultsA total of 64 610 HF patients with no missing value of LVEF from the Swedish Heart Failure Registry were included in the study. Patients were divided according to different LVEFs (<30%, 30–39%, 40–49%, and≥50%) and stratified by an adherence score (good, moderate, or poor) according to the triple, double, and single one usage of GDMT: angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, beta‐blockers, and mineralocorticoid receptor antagonists. The outcome is time to all‐cause mortality. The mean age of the whole cohort was 73.9 ± 12.1 years, and the proportion of patients in LVEF < 30%, 30–39%, 40–49%, and≥50% groups was 27.6%, 26.9%, 22.1%, and 23.3%, respectively. Patients with LVEF < 30% had the highest mortality rate, almost 20% higher than those with LVEF ≥ 50% {hazard ratio [HR] [95% confidence interval (CI)]: 0.80 [0.71–0.90], P < 0.001}. After treatment of GDMT with good adherence, patients with LVEF < 30% had similar mortality to those with LVEF ≥ 50% [HR (95% CI): 0.97 (0.86–1.10), P = 0.664]. However, the percentage of moderate or poor GDMT was alarmingly high, with good adherence only in 20% of the patients.ConclusionsGood adherence to GDMT works best in patients with LVEF < 50%, whereas moderate adherence to GDMT varies in efficacy depending on the components of the drug combinations.

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Age- and sex-related differences in use of guideline-recommended care and mortality among patients with incident heart failure in Denmark

Abstract: older patients with HF were less likely to receive guideline-recommended processes of care, irrespective of sex. Lower level of care may contribute to an excess mortality observed among the older patients.

Cited by 10 publications

References 25 publications

Inequalities in heart failure care in a tax‐financed universal healthcare system: a nationwide population‐based cohort study

Inequalities in heart failure care in a tax‐financed universal healthcare system: a nationwide population‐based cohort study

Heart Failure and Multimorbidity in Australian General Practice

Impact of adherence to guideline‐directed therapy on risk of death in HF patients across an ejection fraction spectrum

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