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

Nichols, Gregory A.; Reynolds, Kristi; Kimes, Teresa M.; Rosales, A. Gabriela; Chan, Wing

doi:10.1016/j.amjcard.2015.07.018

Cited by 91 publications

(79 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…who found 28 day and 1 year all‐cause readmission rates of 25% and 63%, respectively, of which 40% were due to HF. A recent study25 comparing all‐cause readmission between HFpEF and HFrEF showed similar rates, with 30 day readmission rates of 20% and 19%, respectively, while the 1 year readmission rates were 55% and 58%, respectively. Despite the decrease in age‐standardized HF hospitalization over the last few decades in some countries,2, 22, 26, 27 the rates increased in other countries like Germany and Spain 28, 29.…”

Section: Discussionmentioning

confidence: 88%

Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014

et al. 2017

View full text Add to dashboard Cite

AimsThe aim of the current study is to examine 10 year trends in mortality and readmission following heart failure (HF) hospitalization in metropolitan and regional Australian settings.Methods and resultsWe identified all index HF hospitalizations in the Hunter New England region from 2005 to 2014, using a 10 year ‘look back’ period. The primary endpoint was a composite of all‐cause mortality or all‐cause readmission at 1 year. Secondary endpoints included all‐cause mortality, all‐cause readmission, and HF readmission at 30 days and 1 year. We used logistic regression to explore the predictors of the composite outcome of either all‐cause death or readmission at 1 year. There were 12 114 patients admitted with a first episode of HF between 2005 and 2014, followed up until death or the end of 2015. The mean age was 78 ± 12 years and 49% (n = 5906) were male. A total of 4831 (40%) resided in regional areas and the remainder in metropolitan areas. One hundred sixty‐eight patients (1.4%) were Aboriginal. Approximately 69% of patients had either died or been readmitted for any cause within 12 months of their index event. The 30 day and 1 year all‐cause mortality rates were 13% and 32%, respectively, with no change in the trend over the study period. Age, socio‐economic disadvantage, ischaemic heart disease, renal failure, and chronic lower respiratory disease were predictors of the primary endpoint.ConclusionsHeart failure hospitalizations are followed by high rates of death or readmission. There was no change in this composite endpoint over the 10 year study period.

show abstract

Section: Discussionmentioning

confidence: 88%

Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014

et al. 2017

View full text Add to dashboard Cite

show abstract

“…17 One hallmark of both entities is exercise intolerance, with impairments to skeletal muscle (both limb and respiratory 18 ) playing a key role in exacerbating the symptoms of breathlessness and fatigue. 19 As expected, we found numerous skeletal muscle alterations that were similar between HFrEF and HFpEF (Table), included a reduced expression in the anabolic factor IGF-1 and a lower antioxidant enzyme activity of SOD in the soleus, whereas in the diaphragm a greater expression of the key atrophic marker MuRF1.…”

Section: Skeletal Muscle Alterations In Hfmentioning

confidence: 99%

Skeletal Muscle Alterations Are Exacerbated in Heart Failure With Reduced Compared With Preserved Ejection Fraction

Seiler

Bowen

Rolim

et al. 2016

Circ: Heart Failure

View full text Add to dashboard Cite

show abstract

“…After adjusting for age, sex and other covariates, mortality has been demonstrated to be lower in patients with HFpEF. 81,85 Therefore, we adjusted survival in the HFpEF subgroup evaluated in our model, using results from a cohort of more than 6500 patients hospitalised for HF, which reported an adjusted 1-year mortality RR of 1.25 (95% CI 1.12 to 1.41) in patients with HFrEF versus HFpEF. 81 Relative effects: mortality Troughton et al 25 conducted a systematic review and IPD meta-analysis to evaluate the effect of BNP-guided monitoring on a primary outcome of all-cause mortality and secondary outcomes, including all-cause and HF-specific hospitalisation.…”

Section: Model-based Cost-effectiveness Analysismentioning

confidence: 99%

“…81,85 Therefore, we adjusted survival in the HFpEF subgroup evaluated in our model, using results from a cohort of more than 6500 patients hospitalised for HF, which reported an adjusted 1-year mortality RR of 1.25 (95% CI 1.12 to 1.41) in patients with HFrEF versus HFpEF. 81 Relative effects: mortality Troughton et al 25 conducted a systematic review and IPD meta-analysis to evaluate the effect of BNP-guided monitoring on a primary outcome of all-cause mortality and secondary outcomes, including all-cause and HF-specific hospitalisation. For the primary outcome, their meta-analysis was based on eight RCTs, 52,54,58,59,61-64 which provided IPD on 2000 patients, 994 of whom were randomised to the CG group and 1006 were randomised to the BNP-guided group.…”

Section: Model-based Cost-effectiveness Analysismentioning

confidence: 99%

Effectiveness and cost-effectiveness of serum B-type natriuretic peptide testing and monitoring in patients with heart failure in primary and secondary care: an evidence synthesis, cohort study and cost-effectiveness model

Pufulete

Maishman

Dabner

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

BackgroundHeart failure (HF) affects around 500,000 people in the UK. HF medications are frequently underprescribed and B-type natriuretic peptide (BNP)-guided therapy may help to optimise treatment.ObjectiveTo evaluate the clinical effectiveness and cost-effectiveness of BNP-guided therapy compared with symptom-guided therapy in HF patients.DesignSystematic review, cohort study and cost-effectiveness model.SettingA literature review and usual care in the NHS.Participants(a) HF patients in randomised controlled trials (RCTs) of BNP-guided therapy; and (b) patients having usual care for HF in the NHS.InterventionsSystematic review: BNP-guided therapy or symptom-guided therapy in primary or secondary care.Cohort study: BNP monitored (≥ 6 months’ follow-upandthree or more BNP testsandtwo or more tests per year), BNP tested (≥ 1 tests but not BNP monitored) or never tested.Cost-effectiveness model: BNP-guided therapy in specialist clinics.Main outcome measuresMortality, hospital admission (all cause and HF related) and adverse events; and quality-adjusted life-years (QALYs) for the cost-effectiveness model.Data sourcesSystematic review: Individual participant or aggregate data from eligible RCTs.Cohort study: The Clinical Practice Research Datalink, Hospital Episode Statistics and National Heart Failure Audit (NHFA).Review methodsA systematic literature search (five databases, trial registries, grey literature and reference lists of publications) for published and unpublished RCTs.ResultsFive RCTs contributed individual participant data (IPD) and eight RCTs contributed aggregate data (1536 participants were randomised to BNP-guided therapy and 1538 participants were randomised to symptom-guided therapy). For all-cause mortality, the hazard ratio (HR) for BNP-guided therapy was 0.87 [95% confidence interval (CI) 0.73 to 1.04]. Patients who were aged < 75 years or who had heart failure with a reduced ejection fraction (HFrEF) received the most benefit [interactions (p = 0.03): < 75 years vs. ≥ 75 years: HR 0.70 (95% CI 0.53 to 0.92) vs. 1.07 (95% CI 0.84 to 1.37); HFrEF vs. heart failure with a preserved ejection fraction (HFpEF): HR 0.83 (95% CI 0.68 to 1.01) vs. 1.33 (95% CI 0.83 to 2.11)]. In the cohort study, incident HF patients (1 April 2005–31 March 2013) were never tested (n = 13,632), BNP tested (n = 3392) or BNP monitored (n = 71). Median survival was 5 years; all-cause mortality was 141.5 out of 1000 person-years (95% CI 138.5 to 144.6 person-years). All-cause mortality and hospital admission rate were highest in the BNP-monitored group, and median survival among 130,433 NHFA patients (1 January 2007–1 March 2013) was 2.2 years. The admission rate was 1.1 patients per year (interquartile range 0.5–3.5 patients). In the cost-effectiveness model, in patients aged < 75 years with HFrEF or HFpEF, BNP-guided therapy improves median survival (7.98 vs. 6.46 years) with a small QALY gain (5.68 vs. 5.02) but higher lifetime costs (£64,777 vs. £58,139). BNP-guided therapy is cost-effective at a threshold of £20,000 per QALY.LimitationsThe limitations of the trial were a lack of IPD for most RCTs and heterogeneous interventions; the inability to identify BNP monitoring confidently, to determine medication doses or to distinguish between HFrEF and HFpEF; the use of a simplified two-state Markov model; a focus on health service costs and a paucity of data on HFpEF patients aged < 75 years and HFrEF patients aged ≥ 75 years.ConclusionsThe efficacy of BNP-guided therapy in specialist HF clinics is uncertain. If efficacious, it would be cost-effective for patients aged < 75 years with HFrEF. The evidence reviewed may not apply in the UK because care is delivered differently.Future workIdentify an optimal BNP-monitoring strategy and how to optimise HF management in accordance with guidelines; update the IPD meta-analysis to include the Guiding Evidence Based Therapy Using Biomarker Intensified Treatment (GUIDE-IT) RCT; collect routine long-term outcome data for completed and ongoing RCTs.Trial registrationCurrent Controlled Trials ISRCTN37248047 and PROSPERO CRD42013005335.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 40. See the NIHR Journals Library website for further project information. The British Heart Foundation paid for Chris A Rogers’ and Maria Pufulete’s time contributing to the study. Syed Mohiuddin’s time is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust. Rachel Maishman contributed to the study when she was in receipt of a NIHR Methodology Research Fellowship.

show abstract

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

Cited by 91 publications

References 15 publications

Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014

Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014

Skeletal Muscle Alterations Are Exacerbated in Heart Failure With Reduced Compared With Preserved Ejection Fraction

Effectiveness and cost-effectiveness of serum B-type natriuretic peptide testing and monitoring in patients with heart failure in primary and secondary care: an evidence synthesis, cohort study and cost-effectiveness model

Contact Info

Product

Resources

About