Abstract
Background
Up to 50% of hospitalised heart failure (HF) patients are frail and have worse clinical outcomes than non-frail patients. Frail HF patients are less likely to receive HF-specific pharmacotherapy (beta blockers, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), spironolactone) because its benefits in this population are less clear. This study investigated whether frail hospitalised HF patients benefit from the use of HF-specific pharmacotherapy.
Methods
This retrospective study included data of all HF admissions over a period of 7 years at two tertiary hospitals in Australia. Frailty status of patients was determined by use of the Hospital Frailty Risk Score (HFRS) and patients with HFRS ≥5 were classified as frail. The primary outcome for this study was the days-alive-and-out-of-hospital at 90 days (DAOH90) of hospital discharge. Propensity score matching (PSM) was used to match 12 covariates among frail patients who received and those who did not receive HF-specific pharmacotherapy and the average treatment effect (ATE) was determined.
Results
Of 5,734 admissions, 1,406 (24.5%) patients were identified as frail, of whom, 1,025 (72.9%) received one or more HF-specific pharmacotherapy compared to 381 (27.1%) who did not receive any HF-specific medications. Frail patients who received treatment were significantly younger, with a lower creatinine and brain natriuretic peptide (BNP) levels than those who did not receive treatment (p<0.05). PSM created 467 perfectly matched patients in each group. The DAOH90 was significantly increased among those frail patients who received treatment compared to those who did not receive treatment (coefficient 12.7, 95% CI 1.15–24.42, p=0.031).
Conclusion
Use of HF-specific pharmacotherapy is associated with better clinical outcomes in frail hospitalised HF patients.
Up to 50% of hospitalised heart failure (HF) patients are frail and have worse clinical outcomes than non-frail patients. Frail HF patients are less likely to receive HF-specific pharmacotherapy (beta blockers, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), spironolactone) because its benefits in this population are less clear. This study investigated whether frail hospitalised HF patients benefit from the use of HF-specific pharmacotherapy.
Methods
This retrospective study included data of all HF admissions over a period of 7 years at two tertiary hospitals in Australia. Frailty status of patients was determined by use of the Hospital Frailty Risk Score (HFRS) and patients with HFRS ≥5 were classified as frail. The primary outcome for this study was the days-alive-and-out-of-hospital at 90 days (DAOH90) of hospital discharge. Propensity score matching (PSM) was used to match 12 covariates among frail patients who received and those who did not receive HF-specific pharmacotherapy and the average treatment effect (ATE) was determined.
Results
Of 5,734 admissions, 1,406 (24.5%) patients were identified as frail, of whom, 1,025 (72.9%) received one or more HF-specific pharmacotherapy compared to 381 (27.1%) who did not receive any HF-specific medications. Frail patients who received treatment were significantly younger, with a lower creatinine and brain natriuretic peptide (BNP) levels than those who did not receive treatment (p<0.05). PSM created 467 perfectly matched patients in each group. The DAOH90 was significantly increased among those frail patients who received treatment compared to those who did not receive treatment (coefficient 12.7, 95% CI 1.15–24.42, p=0.031).
Conclusion
Use of HF-specific pharmacotherapy is associated with better clinical outcomes in frail hospitalised HF patients.
| Original language | English |
|---|---|
| Pages (from-to) | S72 |
| Number of pages | 1 |
| Journal | Heart, Lung and Circulation |
| Volume | 31 |
| Issue number | Suppl. 3 |
| DOIs | |
| Publication status | Published - 2 Aug 2022 |
Keywords
- Pharmacotherapy
- Heart disease
- Heart failure