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

Ambarish Pandey; Harsh Golwala; Adam D. DeVore; Di Lu; George Madden; Deepak L. Bhatt; Phillip J. Schulte; Paul A. Heidenreich; Clyde W. Yancy; Adrian F. Hernandez; Gregg C. Fonarow

doi:10.1016/j.jchf.2016.03.002

JACC: Heart Failure

Volume 4, Issue 8, August 2016 DOI: 10.1016/j.jchf.2016.03.002

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

Ambarish Pandey, Harsh Golwala, Adam D. DeVore, Di Lu, George Madden, Deepak L. Bhatt, Phillip J. Schulte, Paul A. Heidenreich, Clyde W. Yancy, Adrian F. Hernandez and Gregg C. Fonarow

Author + information

vol. 4 no. 8 649-661

DOI:

https://doi.org/10.1016/j.jchf.2016.03.002

Published By:

JACC: Heart Failure

Print ISSN:

2213-1779

Online ISSN:

2213-1787

History:

Received February 3, 2016
Revision received February 24, 2016
Accepted March 3, 2016
Published online August 1, 2016.

American College of Cardiology Foundation

Author Information

Ambarish Pandey, MD^a,
Harsh Golwala, MD^b,
Adam D. DeVore, MD^c,
Di Lu, MS^c,
George Madden, MD^d,
Deepak L. Bhatt, MD, MPH^e,
Phillip J. Schulte, PhD^c,
Paul A. Heidenreich, MD, MS^f,
Clyde W. Yancy, MD^g,
Adrian F. Hernandez, MD, MHS^c and
Gregg C. Fonarow, MD^h,^∗ (gfonarow{at}mednet.ucla.edu)

^aDivision of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
^bDivision of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky
^cDuke Clinical Research Institute, Durham, North Carolina
^dIntegris Southwest Medical Center, Oklahoma City, Oklahoma
^eBrigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
^fDivision of Cardiology, Stanford University, Palo Alto, California
^gDivision of Cardiology, Northwestern University, Chicago, Illinois
^hRonald Reagan-UCLA Medical Center, Los Angeles, California

↵∗Reprint requests and correspondence:
Dr. Gregg C. Fonarow, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, 10833 LeConte Avenue, Room 47-123 CHS, Los Angeles, California 90095-1679.

Abstract

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.

Key Words

Footnotes

The American Heart Association provides the Get With The Guidelines Heart Failure program (GWTG-HF). GWTG-HF has been previously funded through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the AHA Pharmaceutical Roundtable.
Dr. Devore has received research support from Amgen, the American Heart Association, and Novartis. Dr. Bhatt is a member of the Advisory Board for Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; is a member of the Board of Directors of the Boston VA Research Institute, Society of Cardiovascular Patient Care; is the Chair of the American Heart Association Quality Oversight Committee; is a member of the Data Monitoring Committees for Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, and 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 (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); and other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Vice-Chair), VA CART Research and Publications Committee (Chair); has received research funding from Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, and The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has been a site co-investigator for Biotronik, Boston Scientific, St. Jude Medical; has been a trustee for the American College of Cardiology; and has performed unfunded research for FlowCo, PLx Pharma, and Takeda. Dr. Hernandez has received research funding from Amgen, Janssen, Novartis, Portola, and Bristol-Myers Squibb; and has received consulting fees from Bristol-Myers Squibb, Gilead, Boston Scientific, Janssen, and Novartis. Dr. Fonarow has received research funding from the Agency for Healthcare Research and Quality and National Institutes of Health; and has received consulting fees from Amgen, Baxter, Bayer, Janssen, Novartis, and Medtronic. All other authors have reported that they have no no relationships relevant to the conents of this paper to disclose.