Impact of left ventricular ejection fraction phenotypes on healthcare-resource utilization in hospitalized heart failure: A secondary analysis of REPORT-HF.
Eur J Heart Fail 2023. [PMID:
36974770 DOI:
10.1002/ejhf.2833]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND
Evidence on healthcare resource utilization (HCRU) for hospitalized patients with heart failure (HF) and reduced (HFrEF), mildly-reduced (HFmrEF) and preserved (HFpEF) left ventricular ejection fraction (LVEF) is limited.
METHODS
We analysed HCRU in relation to LVEF phenotypes, clinical features and in-hospital and 12-month outcomes in 16,943 patients hospitalized for HF in a worldwide registry.
RESULTS
HFrEF was more prevalent (53%) than HFmrEF (17%) or HFpEF (30%). Patients with HFmrEF and HFpEF were older, more often women, with milder symptoms and more comorbidities, but differences were not pronounced. HCRU was high in all three groups; 2 or more in- and out-hospital services were required by 51%, 49% and 52% of patients with HFrEF, HFmrEF and HFpEF, respectively, and ICU by 41%, 41% and 37%, respectively.Hospitalization length was similar (median, 8 days). Discharge prescription of neurohormonal inhibitors was <80% for each agent in HFrEF and only slightly lower in HFmrEF and HFpEF (74% and 67%, respectively for beta-blockers). Compared to HFrEF, 12-month all-cause and cardiovascular mortality were lower for HFmrEF [adjusted hazard ratios, 0.76 (0.68-0.84) and 0.77 (0.68-0.88)] and HFpEF [0.62 (0.56-0.68) and 0.60 (0.53-0.68)]; 12-month HF hospitalization was also lower for HFpEF and HFmrEF (21% and 20% versus 25% for HFrEF). In-hospital mortality, 12-month non-cardiovascular mortality and 12-month all-cause hospitalization were similar among groups.
CONCLUSIONS
In patients hospitalized for HF, overall HCRU was similarly high across LVEF spectrum, reflecting the subtle clinical differences among LVEF phenotypes during hospitalization. Discharge prescription of neurohormonal inhibitors were suboptimal in HFrEF and lower but significant in patients with HFpEF and HFmrEF, who had better long-term cardiovascular outcomes than HFrEF, but similar risk for non-cardiovascular events. This article is protected by copyright. All rights reserved.
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