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Temporal trends in risk profiles among patients hospitalized for heart failure.

Publication ,  Journal Article
Hamo, CE; Fonarow, GC; Greene, SJ; Vaduganathan, M; Yancy, CW; Heidenreich, P; Lu, D; Matsouaka, RA; DeVore, AD; Butler, J
Published in: Am Heart J
February 2021

BACKGROUND: Postdischarge mortality following hospitalization for heart failure with reduced ejection fraction (HFrEF) has remained high and unchanged over the past 2 decades, despite effective therapies for HFrEF. We aimed to explore whether these patterns could in part be explained by changes in longitudinal risk profile and HF severity over time. METHODS: Among patients hospitalized for HF in the GWTG-HF registry from January 2005 to December 2018 with available data, we evaluated GWTG-HF and ADHERE risk scores, observing in-hospital mortality per-year. The risk profiles and outcomes were described overall and by subgroups based on ejection fraction (EF), diabetes mellitus (DM), sex, and age. RESULTS: Overall, 335,735 patients were included (50% HFrEF, 46% DM, 48% female, mean age 74 years). In-hospital mortality increased by 2.0% per year from 2005 to 2018. There was no significant change in mean GWTG-HF risk score overall or when stratified by EF groups (P = 0.46 HFrEF, p = 0.26 HF mid-range EF [HFmrEF], and P = 0.72 HF preserved EF [HFpEF]), age, sex, or presence of DM. The observed/expected ratio based on the GWTG-HF risk score was 0.93 (0.91-0.96), 0.83 (0.77-0.90), 0.92 (0.89-95) for HFrEF, HFmrEF, and HFpEF, respectively. Similar findings were seen when risk was assessed using ADHERE risk score. CONCLUSIONS: There were no significant changes in average risk profiles among hospitalized HF patients over the study duration. These data do not support the notion that worsening risk profile explains the lack of improved outcomes despite therapeutic advances, underscoring the importance of aggressive implementation of guideline-recommended therapies and investigation of novel treatments.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2021

Volume

232

Start / End Page

154 / 163

Location

United States

Related Subject Headings

  • White People
  • Stroke Volume
  • Sodium
  • Sex Factors
  • Severity of Illness Index
  • Risk Factors
  • Pulmonary Disease, Chronic Obstructive
  • Odds Ratio
  • Middle Aged
  • Male
 

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Hamo, C. E., Fonarow, G. C., Greene, S. J., Vaduganathan, M., Yancy, C. W., Heidenreich, P., … Butler, J. (2021). Temporal trends in risk profiles among patients hospitalized for heart failure. Am Heart J, 232, 154–163. https://doi.org/10.1016/j.ahj.2020.11.015
Hamo, Carine E., Gregg C. Fonarow, Stephen J. Greene, Muthiah Vaduganathan, Clyde W. Yancy, Paul Heidenreich, Di Lu, Roland A. Matsouaka, Adam D. DeVore, and Javed Butler. “Temporal trends in risk profiles among patients hospitalized for heart failure.Am Heart J 232 (February 2021): 154–63. https://doi.org/10.1016/j.ahj.2020.11.015.
Hamo CE, Fonarow GC, Greene SJ, Vaduganathan M, Yancy CW, Heidenreich P, et al. Temporal trends in risk profiles among patients hospitalized for heart failure. Am Heart J. 2021 Feb;232:154–63.
Hamo, Carine E., et al. “Temporal trends in risk profiles among patients hospitalized for heart failure.Am Heart J, vol. 232, Feb. 2021, pp. 154–63. Pubmed, doi:10.1016/j.ahj.2020.11.015.
Hamo CE, Fonarow GC, Greene SJ, Vaduganathan M, Yancy CW, Heidenreich P, Lu D, Matsouaka RA, DeVore AD, Butler J. Temporal trends in risk profiles among patients hospitalized for heart failure. Am Heart J. 2021 Feb;232:154–163.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2021

Volume

232

Start / End Page

154 / 163

Location

United States

Related Subject Headings

  • White People
  • Stroke Volume
  • Sodium
  • Sex Factors
  • Severity of Illness Index
  • Risk Factors
  • Pulmonary Disease, Chronic Obstructive
  • Odds Ratio
  • Middle Aged
  • Male