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Treatment patterns and clinical outcomes among patients <65 years with a worsening heart failure event
Author(s) -
Butler Javed,
Yang Mei,
Sawhney Baanie,
Chakladar Sreya,
Yang Lingfeng,
Djatche Laurence M.
Publication year - 2021
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.2252
Subject(s) - medicine , heart failure , ejection fraction , emergency department , guideline , retrospective cohort study , diuretic , emergency medicine , pediatrics , pathology , psychiatry
Abstract Aims Data regarding patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF) following a worsening HF event (WHFE) are largely driven by findings from elderly patients. Younger patients are not well studied. The aim of this study was to evaluate treatment patterns and clinical outcomes in commercially insured chronic HFrEF patients <65 years old during 1‐year periods before and after a WHFE. Methods and results A retrospective claims analysis was performed using the IBM® MarketScan® Commercial Database on HFrEF patients aged <65 years during the year before and after a WHFE, defined as HF hospitalization or outpatient intravenous diuretic use. Treatment patterns, rehospitalizations, health care resource utilization, and costs were assessed. A total of 4460 HFrEF patients with WHFE were included. Guideline‐recommended HF therapy was initially underutilized, increased pre‐WHFE, and peaked 0–3 months post‐WHFE. The proportions of patients using dual and triple therapy were 31.5% and 9.8% pre‐WHFE, 41.5% and 17.4% 0–3 months post‐WHFE, and 34.6% and 13.9% 10–12 months post‐WHFE, respectively. Within 30 and 90 days after a WHFE, 12% and 23% of patients had HF‐related and 16% and 30% had all‐cause rehospitalizations, respectively. HF‐related and all‐cause hospitalizations and outpatient visits peaked 0–3 months post‐WHFE, whereas emergency department visits peaked 0–3 months pre‐WHFE. Conclusions Use of HF medications increased pre‐WHFE but decreased post‐WHFE, despite recurrent hospitalizations. These findings suggest that age and insurance status may not totally explain the suboptimal treatment of HFrEF patients before and after a WHFE. Reasons for these trends need further study.