Clinical Profile, Health Care Costs, and Outcomes of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction

Josephine Harrington; Jie Lena Sun; Gregg C. Fonarow; Stephen B. Heitner; Punag H. Divanji; Gary Binder; Larry A. Allen; Brooke Alhanti; Clyde W. Yancy; Nancy M. Albert; Adam D. Devore; G. Michael Felker; Stephen J. Greene

doi:10.1161/JAHA.122.028820

Clinical Profile, Health Care Costs, and Outcomes of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction

Josephine Harrington, Jie Lena Sun, Gregg C. Fonarow, Stephen B. Heitner, Punag H. Divanji, Gary Binder, Larry A. Allen, Brooke Alhanti, Clyde W. Yancy, Nancy M. Albert, Adam D. Devore, G. Michael Felker, Stephen J. Greene^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

BACKGROUND: Many patients with heart failure (HF) have severely reduced ejection fraction but do not meet threshold for con-sideration of advanced therapies (ie, stage D HF). The clinical profile and health care costs associated with these patients in US practice is not well described. METHODS AND RESULTS: We examined patients hospitalized for worsening chronic heart failure with reduced ejection fraction ≤40% from 2014 to 2019 in the GWTG-HF (Get With The Guidelines-Heart Failure) registry, who did not receive advanced HF therapies or have end-stage kidney disease. Patients with severely reduced EF defined as EF ≤30% were compared with those with EF 31% to 40% in terms of clinical profile and guideline-directed medical therapy. Among Medicare beneficiaries, postdischarge outcomes and health care expenditure were compared. Among 113 348 patients with EF ≤40%, 69% (78 589) had an EF ≤30%. Patients with severely reduced EF ≤30% tended to be younger and were more likely to be Black. Patients with EF ≤30% also tended to have fewer comorbidities and were more likely to be prescribed guideline-directed medical therapy (“triple therapy” 28.3% versus 18.2%, P<0.001). At 12-months postdischarge, patients with EF ≤30% had significantly higher risk of death (HR, 1.13 [95% CI, 1.08–1.18]) and HF hospitalization (HR, 1.14 [95% CI, 1.09–1.19]), with similar risk of all-cause hospitalizations. Health care expenditures were numerically higher for patients with EF ≤30% (median US$22 648 versus $21 392, P=0.11). CONCLUSIONS: Among patients hospitalized for worsening chronic heart failure with reduced ejection fraction in US clinical practice, most patients have severely reduced EF ≤30%. Despite younger age and modestly higher use of guideline-directed medical therapy at discharge, patients with severely reduced EF face heightened postdischarge risk of death and HF hospitalization.

Original language	English (US)
Article number	e028820
Journal	Journal of the American Heart Association
Volume	12
Issue number	10
DOIs	https://doi.org/10.1161/JAHA.122.028820
State	Published - 2023

Funding

Cytokinetics, Janssen, Medtronic, Merck, and Novartis. Drs. Heitner and Divanji are employees of Cytokinetics and hold stock in the company (South San Francisco, CA). Mr. Binder was an employee of Cytokinetics (South San Francisco, CA) at the time of this study. Dr Allen reports grant support from National Institutes of Health and patient-centered outcomes research institute, and consulting fees from applied clinical intelligence Clinical, American Heart Association, Boston Scientific, Cytokinetics, Novartis, and UpToDate. Dr Albert has received grant support from AstraZeneca and Novartis and consulting fees from Boston Scientific, Boehringer Ingelheim/ Lilly, Cytokinetics, Novartis, and Merck. Dr Felker has received research grants from National Heart, Lung, and Blood Institute, American Heart Association, Amgen, Bayer, Bristol Myers Squibb (BMS), Merck, Cytokinetics, and CSL-Behring; he has acted as a consultant to Novartis, Amgen, BMS, Cytokinetics, Medtronic, Cardionomic, Boehringer-Ingelheim, American Regent, Abbott, Astra-Zeneca, Reprieve, Myovant, Sequana, Windtree Therapeutics, and Whiteswell, and has served on clinical end point committees/data safety monitoring boards for Amgen, Merck, Medtronic, EBR Systems, V-Wave, LivaNova, Siemens, and Rocket Pharma. Dr Greene has received research support from the Duke University Department of Medicine Chair’s Research Award, American Heart Association (#929502), National Heart Lung and Blood Institute, Amgen, AstraZeneca, Bristol Myers Squibb, Cytokinetics, Merck, Novartis, Pfizer, and Sanofi; has served on advisory boards for Amgen, AstraZeneca, Boehringer Ingelheim/ Lilly, Bristol Myers Squibb, Cytokinetics, Roche Diagnostics, Sanofi, and scPharmaceuticals; serves as a consultant for Amgen, Bayer, Boehringer Ingelheim/ Lilly, Bristol Myers Squibb, CSL Vifor, Merck, PharmaIN, Roche Diagnostics, Sanofi, Tricog Health, and Urovant Pharmaceuticals; and has received speaker fees from Boehringer Ingelheim, Cytokinetics, and Roche Diagnostics. The remaining authors have no disclosures to report.

Keywords

costs
ejection fraction
heart failure
outcomes

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1161/JAHA.122.028820

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Harrington, J., Sun, J. L., Fonarow, G. C., Heitner, S. B., Divanji, P. H., Binder, G., Allen, L. A., Alhanti, B., Yancy, C. W., Albert, N. M., Devore, A. D., Felker, G. M., & Greene, S. J. (2023). Clinical Profile, Health Care Costs, and Outcomes of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction. Journal of the American Heart Association, 12(10), Article e028820. https://doi.org/10.1161/JAHA.122.028820

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title = "Clinical Profile, Health Care Costs, and Outcomes of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction",

abstract = "BACKGROUND: Many patients with heart failure (HF) have severely reduced ejection fraction but do not meet threshold for con-sideration of advanced therapies (ie, stage D HF). The clinical profile and health care costs associated with these patients in US practice is not well described. METHODS AND RESULTS: We examined patients hospitalized for worsening chronic heart failure with reduced ejection fraction ≤40% from 2014 to 2019 in the GWTG-HF (Get With The Guidelines-Heart Failure) registry, who did not receive advanced HF therapies or have end-stage kidney disease. Patients with severely reduced EF defined as EF ≤30% were compared with those with EF 31% to 40% in terms of clinical profile and guideline-directed medical therapy. Among Medicare beneficiaries, postdischarge outcomes and health care expenditure were compared. Among 113 348 patients with EF ≤40%, 69% (78 589) had an EF ≤30%. Patients with severely reduced EF ≤30% tended to be younger and were more likely to be Black. Patients with EF ≤30% also tended to have fewer comorbidities and were more likely to be prescribed guideline-directed medical therapy (“triple therapy” 28.3% versus 18.2%, P<0.001). At 12-months postdischarge, patients with EF ≤30% had significantly higher risk of death (HR, 1.13 [95% CI, 1.08–1.18]) and HF hospitalization (HR, 1.14 [95% CI, 1.09–1.19]), with similar risk of all-cause hospitalizations. Health care expenditures were numerically higher for patients with EF ≤30% (median US$22 648 versus $21 392, P=0.11). CONCLUSIONS: Among patients hospitalized for worsening chronic heart failure with reduced ejection fraction in US clinical practice, most patients have severely reduced EF ≤30%. Despite younger age and modestly higher use of guideline-directed medical therapy at discharge, patients with severely reduced EF face heightened postdischarge risk of death and HF hospitalization.",

keywords = "costs, ejection fraction, heart failure, outcomes",

author = "Josephine Harrington and Sun, {Jie Lena} and Fonarow, {Gregg C.} and Heitner, {Stephen B.} and Divanji, {Punag H.} and Gary Binder and Allen, {Larry A.} and Brooke Alhanti and Yancy, {Clyde W.} and Albert, {Nancy M.} and Devore, {Adam D.} and Felker, {G. Michael} and Greene, {Stephen J.}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors.",

year = "2023",

doi = "10.1161/JAHA.122.028820",

language = "English (US)",

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Harrington, J, Sun, JL, Fonarow, GC, Heitner, SB, Divanji, PH, Binder, G, Allen, LA, Alhanti, B, Yancy, CW, Albert, NM, Devore, AD, Felker, GM & Greene, SJ 2023, 'Clinical Profile, Health Care Costs, and Outcomes of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction', Journal of the American Heart Association, vol. 12, no. 10, e028820. https://doi.org/10.1161/JAHA.122.028820

TY - JOUR

T1 - Clinical Profile, Health Care Costs, and Outcomes of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction

AU - Harrington, Josephine

AU - Sun, Jie Lena

AU - Fonarow, Gregg C.

AU - Heitner, Stephen B.

AU - Divanji, Punag H.

AU - Binder, Gary

AU - Allen, Larry A.

AU - Alhanti, Brooke

AU - Yancy, Clyde W.

AU - Albert, Nancy M.

AU - Devore, Adam D.

AU - Felker, G. Michael

AU - Greene, Stephen J.

PY - 2023

Y1 - 2023

N2 - BACKGROUND: Many patients with heart failure (HF) have severely reduced ejection fraction but do not meet threshold for con-sideration of advanced therapies (ie, stage D HF). The clinical profile and health care costs associated with these patients in US practice is not well described. METHODS AND RESULTS: We examined patients hospitalized for worsening chronic heart failure with reduced ejection fraction ≤40% from 2014 to 2019 in the GWTG-HF (Get With The Guidelines-Heart Failure) registry, who did not receive advanced HF therapies or have end-stage kidney disease. Patients with severely reduced EF defined as EF ≤30% were compared with those with EF 31% to 40% in terms of clinical profile and guideline-directed medical therapy. Among Medicare beneficiaries, postdischarge outcomes and health care expenditure were compared. Among 113 348 patients with EF ≤40%, 69% (78 589) had an EF ≤30%. Patients with severely reduced EF ≤30% tended to be younger and were more likely to be Black. Patients with EF ≤30% also tended to have fewer comorbidities and were more likely to be prescribed guideline-directed medical therapy (“triple therapy” 28.3% versus 18.2%, P<0.001). At 12-months postdischarge, patients with EF ≤30% had significantly higher risk of death (HR, 1.13 [95% CI, 1.08–1.18]) and HF hospitalization (HR, 1.14 [95% CI, 1.09–1.19]), with similar risk of all-cause hospitalizations. Health care expenditures were numerically higher for patients with EF ≤30% (median US$22 648 versus $21 392, P=0.11). CONCLUSIONS: Among patients hospitalized for worsening chronic heart failure with reduced ejection fraction in US clinical practice, most patients have severely reduced EF ≤30%. Despite younger age and modestly higher use of guideline-directed medical therapy at discharge, patients with severely reduced EF face heightened postdischarge risk of death and HF hospitalization.

AB - BACKGROUND: Many patients with heart failure (HF) have severely reduced ejection fraction but do not meet threshold for con-sideration of advanced therapies (ie, stage D HF). The clinical profile and health care costs associated with these patients in US practice is not well described. METHODS AND RESULTS: We examined patients hospitalized for worsening chronic heart failure with reduced ejection fraction ≤40% from 2014 to 2019 in the GWTG-HF (Get With The Guidelines-Heart Failure) registry, who did not receive advanced HF therapies or have end-stage kidney disease. Patients with severely reduced EF defined as EF ≤30% were compared with those with EF 31% to 40% in terms of clinical profile and guideline-directed medical therapy. Among Medicare beneficiaries, postdischarge outcomes and health care expenditure were compared. Among 113 348 patients with EF ≤40%, 69% (78 589) had an EF ≤30%. Patients with severely reduced EF ≤30% tended to be younger and were more likely to be Black. Patients with EF ≤30% also tended to have fewer comorbidities and were more likely to be prescribed guideline-directed medical therapy (“triple therapy” 28.3% versus 18.2%, P<0.001). At 12-months postdischarge, patients with EF ≤30% had significantly higher risk of death (HR, 1.13 [95% CI, 1.08–1.18]) and HF hospitalization (HR, 1.14 [95% CI, 1.09–1.19]), with similar risk of all-cause hospitalizations. Health care expenditures were numerically higher for patients with EF ≤30% (median US$22 648 versus $21 392, P=0.11). CONCLUSIONS: Among patients hospitalized for worsening chronic heart failure with reduced ejection fraction in US clinical practice, most patients have severely reduced EF ≤30%. Despite younger age and modestly higher use of guideline-directed medical therapy at discharge, patients with severely reduced EF face heightened postdischarge risk of death and HF hospitalization.

KW - costs

KW - ejection fraction

KW - heart failure

KW - outcomes

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Clinical Profile, Health Care Costs, and Outcomes of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction

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ASJC Scopus subject areas

UN SDGs

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