Author + information
- Received April 17, 2015
- Revision received June 1, 2015
- Accepted June 12, 2015
- Published online November 1, 2015.
- Supriya Shore, MD, MSCS∗,
- Maria V. Grau-Sepulveda, MD, MPH†,
- Deepak L. Bhatt, MD, MPH‡,
- Paul A. Heidenreich, MD, MS§,
- Zubin J. Eapen, MD, MHS†,
- Adrian F. Hernandez, MD, MHS†,
- Clyde W. Yancy, MD‖ and
- Gregg C. Fonarow, MD¶∗ ()
- ∗Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- †Duke Clinical Research Institute, Durham, North Carolina
- ‡Division of Cardiology, Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
- §Division of Cardiology, Stanford University, Palo Alto, California
- ‖Division of Cardiology, Northwestern University, Chicago, Illinois
- ¶Division of Cardiology, University of California, Los Angeles, California
- ↵∗Reprint requests and correspondence:
Dr. Gregg C. Fonarow, Department of Medicine, Division of Cardiology, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, California 50095-1679.
Objectives The authors sought to describe characteristics, treatments, and in-hospital outcomes of hospitalized heart failure (HF) patients stratified by etiology.
Background Whether characteristics and outcomes of HF patients differ by cardiomyopathy etiology is unknown.
Methods The authors analyzed data on 156,013 hospitalized HF patients from 319 U.S. hospitals participating in Get With The Guidelines–HF between 2005 and 2013. Characteristics, treatments, and in-hospital outcomes were assessed by HF etiology. Standard regression techniques adjusted for site and patient-level characteristics were used to examine association between HF etiology and in-hospital outcomes.
Results Median age was 75 years, 69.2% were white, and 49.5% were women. Overall, 92,361 patients (59.2%) had ischemic cardiomyopathy and 63,652 patients (40.8%) had nonischemic cardiomyopathy (NICM). Hypertensive (n = 28,141; 48.5%) and idiopathic (n = 17,808; 30.7%) cardiomyopathies accounted for the vast majority of NICM patients. Post-partum (n = 209; 0.4%), viral (n = 447; 0.8%), chemotherapy (n = 721; 1.2%), substance abuse (n = 2,653; 4.6%), familial (n = 556; 1.0%), and other (n = 7,523; 13.0%) etiologies were far less frequent. There were significant differences in baseline characteristics between those with ischemic cardiomyopathy compared with NICM with respect to age (76 years vs. 72 years), sex (44.4% vs. 56.9% women), and ejection fraction (38% vs. 45%). Risk-adjusted quality of care provided to eligible patients varied minimally by etiology. Similarly, in-hospital mortality did not differ among ischemic compared with NICM patients. However, among NICM patients, only hypertensive cardiomyopathy had a lower mortality rate compared with idiopathic NICM (adjusted odds ratio: 0.83; 95% confidence interval: 0.71 to 0.97).
Conclusions Characteristics of hospitalized HF patients vary by etiology. Both risk-adjusted quality of care and in-hospital outcomes did not differ by etiology.
This study was supported by the Young Investigator Database Research Seed Grant-supported by the Council on Clinical Cardiology, the Stroke Council, and the Council on Quality of Care and Outcomes Research. The Get With The Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. Dr. Bhatt is on the Advisory Board of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; is on the Board of Directors of Boston VA Research Institute and Society of Cardiovascular Patient Care; has received research funding from Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company; has done unfunded research for FlowCo, PLx Pharma, and Takeda; is the Chair of the American Heart Association Get With The Guidelines Steering Committee; is on the Data Monitoring Committees of Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute; has received honoraria from the American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Associate Editor; Section Editor, Pharmacology), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), and WebMD (CME steering committees); and is a Deputy Editor of Clinical Cardiology. Dr. Eapen is on the Advisory Boards of Novartis and Cytokinetics; has received honoraria from Janssen; and is a consultant for Amgen. Dr. Hernandez is on the Advisory Boards of Bristol-Myers Squibb, Novartis, Gilead, Boston Scientific, and Janssen; and has received research grants from Janssen, Bristol-Myers Squibb, Novartis, Portola, Amgen, AstraZeneca, GlaxoSmithKline, and Merck. Dr. Fonarow is a consultant for Amgen, Novartis, Baxter, Bayer, Johnson & Johnson, and Medtronic; and has received research grants from Novartis, Gambro, National Heart, Lung, and Blood Institute, and National Institutes of Health/National Institute of Allergy and Infectious Diseases. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 17, 2015.
- Revision received June 1, 2015.
- Accepted June 12, 2015.
- American College of Cardiology Foundation