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Impact of recurrent heart failure hospitalizations on cardiovascular mortality in patients with heart failure in CPRD, a UK database

Session Poster Session 1

Speaker Raquel Lahoz

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : R Lahoz (Basel,CH), A Fagan (Dublin,IE), M Mcsharry (Dublin,IE), CWJ Proudfoot (Basel,CH), S Corda (Basel,CH), R Studer (Basel,CH)

Authors:
R Lahoz1 , A Fagan2 , M Mcsharry2 , CWJ Proudfoot3 , S Corda4 , R Studer3 , 1Novartis Pharma AG, Real World Evidence and Digital - Basel - Switzerland , 2Novartis Ireland Limited, Real World Data Analytics - Dublin - Ireland , 3Novartis Pharma AG, Global Patient Access - Basel - Switzerland , 4Novartis Pharma AG, Global Medical Affairs - Basel - Switzerland ,

Citation:

Background. Heart failure (HF) is a leading cause of hospitalization among older adults. Previous studies have suggested that recurrent heart failure hospitalizations are a predictor of cardiovascular (CV) and all-cause mortality. Purpose. This study examined the impact of recurrent HF hospitalizations on CV mortality in real-world UK HF patients.  Methods. Adult HF patients identified in the CPRD database with a first (index) hospitalization due to HF recorded in the HES dataset from 01/01/2010 to 31/12/2014 were included. Patients were followed until death or end of study period (31/12/2017). CV death as primary and as any reported cause and all cause death were evaluated. An extended Cox regression model was used for reporting adjusted relative CV mortality rates for time dependent recurrent HF hospitalizations. Adjusted variables were included based on clinical importance or statistical  significance at baseline and if missing values were below 30%. 
Results.  8603 HF patients with an index hospitalization were included, providing 15975 patient-years follow-up. Patients were relatively old (median [IQR] age of 80 [71-86]); majority were male (54.6%), with main comorbidities being hypertension (65.0%), atrial fibrillation (53.3%) and ischemic heart diseases (48.0%). LVEF values were only available for 1.9% of the sample so were not used in the analysis. Recurrent HF hospitalizations occurred 1, 2, 3 and =4 times in 1568 (18.2%), 496 (5.8%), 190 (2.2%) and 144(1.7%) patients, respectively. The median (IQR) time to all cause death was 215 (38-664) for the 50.8% of patients that died during the study period, and 139 (27-531) days for the 31.3% who died due to CV death recorded as primary cause. Compared with those without recurrent HF hospitalizations, the adjusted hazard ratios for CV death were 2.8 (95%CI 2.5-3.1), 3.5 (95% CI 2.9-4.2), 6.2 (95% CI 4.9-7.9) and 6.3 (95% CI 4.7-8.4) for 1, 2, 3 and =4 recurrent HF hospitalizations. Conclusion. Recurrent HF hospitalizations are a strong predictor of CV death in the HF population. The risk of CV death and all-cause death increases progressively with each recurrent HF hospitalization. These data highlight the relevance of reducing hospitalizations in the management of HF.

0 recurrent HF hosp

n=6205 (72.1%)

1 recurrent HF hosp

n=1568 (18.2%)

2 recurrent HF hosp

n=496 (5.8%)

3 recurrent HF hosp

n=190 (2.2%)

4+ recurrent HF hosp n=144 (1.7%) All patients n=8603 (100.0%)

Follow-up time (days) from respective recurrent HF hospitalization(median [IQR])

402 [71-1009] 176 [33-622] 87 [21-383] 67 [20-272] 157 [50-403] 305 [50-879]
All-cause death (n (%)) 3050 (49.1%) 841 (53.6%) 273 (55.0%) 121 (63.7%) 87 (60.4%) 4372 (50.8%)
CV death- any cause (n (%)) 2642 (42.6%) 773 (49.3%) 260 (52.4%) 115 (60.5%) 82 (56.9%) 3872 (45.0%)
CV death- primary cause(n(%)) 1804 (29.1%) 557 (35.5%) 185 (37.3%) 88 (46.3%) 63 (43.7%) 2697 (31.3%)

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