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Trends in the Use of Guideline-Directed Therapies Among Dialysis Patients Hospitalized With Systolic Heart Failure: Findings From the American Heart Association Get With The Guidelines-Heart Failure Program.

Publication ,  Journal Article
Pandey, A; Golwala, H; DeVore, AD; Lu, D; Madden, G; Bhatt, DL; Schulte, PJ; Heidenreich, PA; Yancy, CW; Hernandez, AF; Fonarow, GC
Published in: JACC Heart Fail
August 2016

OBJECTIVES: The purpose of this study was to determine the temporal trends in the adherence to heart failure (HF)-related process of care measures and clinical outcomes among patients with acute decompensated HF with reduced ejection fraction (HFrEF) and end-stage renal disease (ESRD). BACKGROUND: Previous studies have demonstrated significant underuse of evidence-based HF therapies among patients with coexisting ESRD and HFrEF. However, it is unclear if the proportional use of evidence-based medical therapies and associated clinical outcomes among these patients has changed over time. METHODS: Get With The Guidelines-HF study participants who were admitted for acute HFrEF between January 2005 and June 2014 were stratified into 3 groups on the basis of their admission renal function: normal renal function, renal insufficiency without dialysis, and dialysis. Temporal change in proportional adherence to the HF-related process of care measures and incidence of clinical outcomes (1-year mortality, HF hospitalization, and all-cause hospitalization) during the study period was evaluated across the 3 renal function groups. RESULTS: The study included 111,846 patients with HFrEF from 390 participating centers, of whom 19% had renal insufficiency but who did not require dialysis, and 3% were on dialysis. There was a significant temporal increase in adherence to evidence-based medical therapies (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker: p trend <0.0001, β-blockers: p trend = 0.0089; post-discharge follow-up referral: p trend <0.0001) and defect-free composite care (p trend <0.0001) among dialysis patients. An improvement in adherence to these measures was also observed among patients with normal renal function and patients with renal insufficiency without a need for dialysis. There was no significant change in cumulative incidence of clinical outcomes over time among the HF patients on dialysis. CONCLUSIONS: In a large contemporary cohort of HFrEF patients with ESRD, adherence to the HF process of care measures has improved significantly over the past 10 years. Unlike patients with normal renal function, there was no significant change in 1-year clinical outcomes over time among HF patients on dialysis.

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

August 2016

Volume

4

Issue

8

Start / End Page

649 / 661

Location

United States

Related Subject Headings

  • United States
  • Stroke Volume
  • Renal Insufficiency, Chronic
  • Renal Dialysis
  • Referral and Consultation
  • Quality of Health Care
  • Proportional Hazards Models
  • Practice Guidelines as Topic
  • Mortality
  • Middle Aged
 

Citation

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Pandey, A., Golwala, H., DeVore, A. D., Lu, D., Madden, G., Bhatt, D. L., … Fonarow, G. C. (2016). Trends in the Use of Guideline-Directed Therapies Among Dialysis Patients Hospitalized With Systolic Heart Failure: Findings From the American Heart Association Get With The Guidelines-Heart Failure Program. JACC Heart Fail, 4(8), 649–661. https://doi.org/10.1016/j.jchf.2016.03.002
Pandey, Ambarish, Harsh Golwala, Adam D. DeVore, Di Lu, George Madden, Deepak L. Bhatt, Phillip J. Schulte, et al. “Trends in the Use of Guideline-Directed Therapies Among Dialysis Patients Hospitalized With Systolic Heart Failure: Findings From the American Heart Association Get With The Guidelines-Heart Failure Program.JACC Heart Fail 4, no. 8 (August 2016): 649–61. https://doi.org/10.1016/j.jchf.2016.03.002.
Pandey A, Golwala H, DeVore AD, Lu D, Madden G, Bhatt DL, Schulte PJ, Heidenreich PA, Yancy CW, Hernandez AF, Fonarow GC. Trends in the Use of Guideline-Directed Therapies Among Dialysis Patients Hospitalized With Systolic Heart Failure: Findings From the American Heart Association Get With The Guidelines-Heart Failure Program. JACC Heart Fail. 2016 Aug;4(8):649–661.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

August 2016

Volume

4

Issue

8

Start / End Page

649 / 661

Location

United States

Related Subject Headings

  • United States
  • Stroke Volume
  • Renal Insufficiency, Chronic
  • Renal Dialysis
  • Referral and Consultation
  • Quality of Health Care
  • Proportional Hazards Models
  • Practice Guidelines as Topic
  • Mortality
  • Middle Aged