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

Research output: Contribution to journalArticlepeer-review

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 languageEnglish (US)
Article numbere028820
JournalJournal of the American Heart Association
Volume12
Issue number10
DOIs
StatePublished - 2023

Keywords

  • costs
  • ejection fraction
  • heart failure
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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