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

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• 作者：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 ; Gregg C. Fonarow ; MD^h ; ^{gfonarow@mednet.ucla.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：dialysis ; heart failure with reduced ejection fraction ; outcomes ; quality of care
• 刊名：JACC: Heart Failure
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：4
• 期：8
• 页码：649-661
• 全文大小：965 K

文摘

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.