Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777. Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized for Heart Failure: A Report From the OPTIMIZE-HF Registry (Organized Program To Initiate life-saving treatMent In hospitaliZEd patients with Heart Failure) Gregg C. Fonarow MD, FACC, Wendy Gattis Stough PharmD, William T. Abraham MD, FACC, Nancy M. Albert PhD, RN, Mihai Gheorghiade MD, FACC, Barry H. Greenberg MD, FACC, Christopher M. O'Connor MD, FACC, Jie Lena Sun MS, Clyde W. Yancy MD, FACC, James B. Young MD, FACC and OPTIMIZE-HF Investigators and Hospitals
21
Embed
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768 777. Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized for Heart Failure: A Report From the OPTIMIZE-HF Registry (Organized Program To Initiate life-saving treatMent In hospitaliZEd patients with Heart Failure)
Gregg C. Fonarow MD, FACC, Wendy Gattis Stough PharmD, William T. Abraham MD, FACC, Nancy M. Albert PhD, RN, Mihai Gheorghiade MD, FACC, Barry H. Greenberg MD, FACC, Christopher M. O'Connor MD, FACC, Jie Lena Sun MS, Clyde W. Yancy MD, FACC, James B. Young MD, FACC and OPTIMIZE-HF Investigators and Hospitals
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
2
Disclosures
• Funding Support– GlaxoSmithKline funded the OPTIMIZE-HF registry
under the guidance of the OPTIMIZE-HF Steering Committee and funded data collection and management by Outcome Sciences, Inc (Cambridge, MA) and analysis of registry data at Duke Clinical Research Institute (Durham, NC)
• Individual author disclosures are listed in the manuscript
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
3
Heart Failure and Preserved Systolic Function
• A substantial portion of patients with heart failure (HF) have relatively normal or preserved systolic function (PSF)
• Heart failure with PSF has been defined as the presence of HF symptoms in patients with a documented left ventricular ejection fraction (EF) of >40% or >50%, depending on the study
• Few data are available in patients with HF and PSF that describe outcomes or guide management strategies
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
4
Study Objective
• The objective of this study was to evaluate the characteristics, treatments, and outcomes of patients with preserved and reduced systolic function heart failure in a large, representative population of patients from all regions of the country.
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
5
OPTIMIZE-HF Program Objectives
• OPTIMIZE-HF is a national performance improvement initiative to improve guidelines adherence in patients hospitalized with HF
• Overall OPTIMIZE-HF program objectives: – Improve medical care and education of patients
hospitalized with HF – Accelerate initiation of HF evidence-based, guideline-
recommended therapies by starting these therapies before hospital discharge in appropriate patients without contraindications
– Increase understanding of barriers to use of ACEIs, -blockers, and other guideline-recommended therapies in eligible HF patients
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
6
OPTIMIZE-HF Process-of-Care Intervention and Registry• “Process-of-care” intervention
– Enhanced inpatient HF care and education– Enhanced discharge planning– Care maps, pathways, and standardized order sets that
encouraged adoption of evidence-based therapies • ACEI and -blocker initiation before discharge• JCAHO performance indicators
– Educational programs to encourage adoption by providers
• Web-based registry – Tracks treatment rates and changes following
performance interventions– Captures JCAHO/ORYX Quality of Care indicators– Benchmarks comparisons between institutions– Enhances understanding of barriers to uptake
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
– Adults hospitalized for episode of new or worsening HF as primary cause of admission, or with significant HF symptoms that develop during hospitalization when the initial reason for admission was not HF
– Includes patients with systolic dysfunction and/or isolated diastolic dysfunction (HF with preserved systolic function)
– Any admission satisfying JCAHO HF core measure criteria
• Prespecified subgroup (10%) with 60–90-day follow-up data– Survival, readmissions, and medical regimen– Informed consent required for follow-up
• The registry coordinating center was Outcome Sciences, Inc
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
8
OPTIMIZE-HF Hospital CharacteristicsTotal Hospitals(N=259), n (%)
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
18
β-Blockers and Post-Discharge Outcomes in PSF (Unadjusted)
No β-blocker β-blocker
Su
rviv
al F
un
ctio
n
0.75
0.80
0.85
0.90
0.95
1.00
0 10 20 30 40 50 60 70 80 90
P=.7741
Survival Time in Days Since Dischargeβ-blocker 1,425 1,365 1,245 292No β-blocker 543 525 484 119
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
19
Risk- and Propensity-Adjusted Analysis of Discharge Medication Use in Patients with PSF
Post-discharge Mortality
Hazard Ratio
95% Hazard Ratio Confidence Limits
P Value
ACEI/ARB vs no ACEI/ARB
1.141 0.812 1.603 .447
β-Blocker vs no β-Blocker
1.209 0.872 1.675 .255
Post-discharge Death and/or Hospitalization
Odds Ratio
95% Odds Ratio Confidence Limits
P Value
ACEI/ARB vs no ACEI/ARB
0.909 0.692 1.196 .497
β-Blocker vs no β-Blocker
0.923 0.723 1.179 .523
PSF = LVEF 40%.
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
20
Limitations
• The present observations include only hospitalized patients with HF, a population known to be at increased risk of adverse outcomes
• Left ventricular function was not assessed in 7,345 patients (15%), and these patients were excluded
• Follow-up data were collected only from a pre-specified subset of patients and extended only 60 to 90 days after hospital discharge
• Despite extensive covariate and propensity adjustment, residual confounding cannot be excluded, thus may only be demonstrating associations, rather than cause-and-effect relationships
Fonarow GC, et al. J Am Coll Cardiol. 2007;50:768777.
21
Conclusions• Data from the OPTIMIZE-HF reveal a high prevalence of
HF with PSF
• These patients have a similar post-discharge mortality risk and equally high rates of rehospitalization as patients with HF and LVSD
• No differences in clinical outcomes were seen with different definitions for PSF
• Despite the burden to patients and health care systems, data are lacking on effective management strategies for patients with HF and PSF
• Large well designed clinical trials are critically needed to identify effective management strategies for this population