Pharmacotherapy Treatment Patterns, Outcomes, and Health Resource Utilization Among Patients with Heart Failure with Reduced Ejection Fraction at a US Academic Medical Center
Pharmacotherapy Treatment Patterns, Outcomes, and Health Resource Utilization Among Patients with Heart Failure with Reduced Ejection Fraction at a US Academic Medical Center
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DOI：
10.1002/phar.1701
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发表时间：
2016-02-01
期刊：
影响因子：
4.1
通讯作者：
Munger, Mark
中科院分区：
文献类型：
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作者：
Bress, Adam P.;King, Jordan B.;Munger, Mark
研究目的评估学术医疗中心环境中射血分数降低 (HFrEF) 心力衰竭患者的临床特征、药物治疗模式、资源利用和相关费用以及发病率和死亡率结果。设计回顾性分析。数据源电子健康记录数据库，包括犹他大学医疗保健系统所有设施的临床、实验室和管理数据。患者总共确定了 989 名患有普遍（既往存在）HFrEF 的成人。 2007年1月1日至2013年6月30日期间，使用国际疾病分类第九版临床修改代码428.x（心力衰竭），左心室射血分数为40%或更低。测量和主要结果该队列的平均年龄为64±15岁，主要是白人（71%）和男性（74%）。患者接受α-受体阻滞剂、血管紧张素转换酶抑制剂（ACEIs）或血管紧张素II受体阻滞剂（ARB）和醛固酮受体拮抗剂（ARA）的比例分别为79%、69%和29%。患者达到β受体阻滞剂、ACEI 和 ARB 目标剂量的比例分别仅为 24%、31% 和 13%。总体而言，58% 的患者接受了 β 受体阻滞剂和 ACEI 或 ARB 的双重治疗，19% 的患者接受了三联治疗（β 受体阻滞剂、ACEI 或 ARB 和 ARA）。使用单变量和多变量逻辑回归模型来评估基线特征与三联疗法之间的关联。两个模型中两个变量均具有统计学显着性：年龄增加与三联疗法的几率降低相关（单变量：比值比 [OR] 0.760，95% 置信区间 [CI] 0.673-0.857；多变量：OR 0.768，95% CI 0.625-0.942），而接受植入式心脏装置与三联疗法的几率增加 2 倍相关（单变量：OR 2.1，95% CI 1.4-3.1；多变量：OR 2.1，95% CI 1.3-3.5）。在 36 +/- 27 个月的平均 +/- SD 随访期间，全因死亡率为每人年 0.12。共有 1311 人因各种原因住院，其中 611 人（47%）因心力衰竭恶化而住院。随访期间，全因住院率和心力衰竭住院率分别为每人年 0.44 例和 0.21 例。中位住院时间为 6.4 +/- 8.8 天，中位费用为 22,310 美元。 30 天全因再入院率为 20%，其中 65% 的病例再入院的主要原因是心力衰竭。结论本研究表明 HFrEF 患者持续承受重大疾病和经济负担。在利用现有的疾病缓解疗法以及治疗 HFrEF 和多种合并症患者方面仍然存在挑战。
Study ObjectiveTo assess clinical characteristics, pharmacotherapy treatment patterns, resource utilization and associated charges, and morbidity and mortality outcomes among a real-world cohort of patients with heart failure with reduced ejection fraction (HFrEF) in an academic medical center setting.DesignRetrospective analysis.Data SourceElectronic health record database that includes clinical, laboratory, and administrative data for all facilities of the University of Utah Health Care System.PatientsA total of 989 adults with prevalent (preexisting) HFrEF, identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification code 428.x (heart failure) between January 1, 2007, and June 30, 2013, and who had a left ventricular ejection fraction of 40% or lower.Measurements and Main ResultsThe cohort had a mean age of 64 15 years and was predominantly white (71%) and male (74%). Patients received -blockers, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), and aldosterone receptor antagonists (ARAs) at rates of 79%, 69%, and 29%, respectively. Patients achieved target doses of -blockers, ACEIs, and ARBs at rates of only 24%, 31%, and 13%, respectively. Overall, 58% of patients were prescribed dual therapy with a -blocker and an ACEI or ARB, and 19% were prescribed triple therapy (-blocker, an ACEI or ARB, and an ARA). Univariate and multivariate logistic regression models were used to assess the association between baseline characteristics with the presence of triple therapy. Two variables were statistically significant in both models: increasing age was associated with a lower odds of triple therapy (univariate: odds ratio [OR] 0.760, 95% confidence interval [CI] 0.673-0.857; multivariate: OR 0.768, 95% CI 0.625-0.942), whereas receipt of an implantable cardiac device was associated with a 2-fold increase in the odds of triple therapy (univariate: OR 2.1, 95% CI 1.4-3.1; multivariate: OR 2.1, 95% CI 1.3-3.5). During a mean +/- SD follow-up of 36 +/- 27 months, all-cause mortality was 0.12 per person-year. There were 1311 all-cause hospitalizations of which 611 (47%) were for worsening heart failure. The rate of all-cause and heart failure-specific hospitalizations was 0.44 and 0.21 per person-year of follow-up, respectively. The median length of stay was 6.4 +/- 8.8 days, and the median charge was $22,310. The 30-day all-cause readmission rate was 20%, and the primary reason for readmission was heart failure in 65% of cases.ConclusionThis study demonstrates the continuing significant disease and economic burden for patients with HFrEF. Challenges remain in utilization of established disease-modifying therapy and in the treatment of patients with HFrEF and multiple comorbidities.