AT THE ESC CONGRESS 2015
LONDON (FRONTLINE MEDICAL NEWS) – More than half of all patients hospitalized for heart failure were readmitted within 1 year of discharge in a large Italian population-based study.
Results from the ARNO-CORE CardioVascular Observatory database showed that 56.6% of 41,417 patients with heart failure who were discharged alive and prescribed at least one drug for heart failure were readmitted to the hospital at least once in the following year, Dr. Aldo Maggioni said at the annual congress of the European Society of Cardiology.
This averaged out to 2.1 readmissions per person, and importantly, those readmissions were frequently for noncardiovascular reasons, he said. Indeed, 23,826 (49.1%) of rehospitalizations were due to respiratory disease, gastrointestinal disease, cancer, trauma, or other reasons.
“This clearly implies that if we want to impact the total burden of [heart failure], we are not to just consider the reduction in hospitalization for heart failure, but we have to take into account the multiplicity of causes that these patients have,” commented Dr. Maggioni of the National Association of Hospital Cardiologists Research Center in Florence, Italy.
The ARNO-CORE CardioVascular Observatory is a large, retrospective observational study looking at the clinical epidemiology of patients with heart failure. Unlike clinical trial populations and even specialty-run heart failure registries, the ARNO database aims to provide a more representative picture of heart failure and its treatment in a routine practice setting, Dr. Maggioni noted.
Of the 41,413 patients with acute heart failure during 2008-2012 included in the present analysis, just over one-quarter (27%) were admitted to a cardiology unit, with the majority (50%) admitted to internal medicine or general medicine practices, and 14% seen in geriatric departments, 2% in functional recovery or rehabilitation units, 2% in pulmonary units, and the remainder in other practices.
The mean age of patients was 78 years, which was older than that seen in heart failure trials such as the RELAX-AHF study (72 years) and the ESC-HF Long-Term Registry (71 years). There was also a higher percentage of women, compared with the percentage for the trial and the other registry population (51% vs. 38% and 27%, respectively), and there were higher incidences of chronic obstructive pulmonary disease (31% vs. 16% and 20%) and depression (21% vs. 8% in the ESC-HF Long-Term Registry). A substantial percentage (31%) had diabetes (48% in RELAX-AHF and 39% in the ESC registry), but a lower percentage was found to have coexistent chronic kidney disease (4% vs. 26% in the ESC registry). The reason for the latter difference was perhaps that it was possible to more accurately include only those patients with chronic kidney disease using the administrative coding, Dr. Maggioni said.
In terms of pharmacologic treatments, fewer patients treated in routine practice than in the clinical trial or ESC registry settings received guideline-recommended therapies. Two-thirds (66%) of patients in the ARNO database were taking ACE inhibitors or angiotensin II receptor blockers (ARBs), compared with 72% and 77% of the RELAX-AHF and ESC registry populations. Furthermore only about half (52%) were taking beta-blockers, compared with 89% and 72% of the trial and other ESC registry populations.
Importantly, patients were being treated with suboptimal doses, he said, and adherence rates at 1 year were 58% for ACE inhibitors and ARBs and 62% for beta-blockers.
All-cause mortality at 1 year was 28.7%, which was higher than that seen in clinical studies such as EVEREST (26.1%) and at 6 months in the RELAX-AHF study (9.2%). It was also slightly higher than that seen in the ESC-HF Long-Term Registry (23.6%).
“The yearly cost for a patient with heart failure is high and mainly driven by hospitalizations,” Dr. Maggioni said. The estimated costs per patient per year were $13,295.04, which is higher than that for cardiovascular disease in general ($10,689.59) and lower than for acute coronary syndrome ($16,664.74). Of this cost, roughly 83% is linked to hospitalization and less than 10% to medications and 7% to specialist diagnostic procedures.
“Given the poor prognosis and the high health care costs associated with hospital readmissions, even small improvements in the global heart failure patient care can have a substantial impact on patient quality of life and health care costs,” Dr. Maggioni suggested. He added that better adherence to guideline-recommended medications could also play a vital role.The study was partially supported by Novartis Pharma Italy. Dr. Maggioni disclosed serving on committees of heart failure trials sponsored by Bayer Healthcare, Cardiorentis, and Novartis Pharma Italy.
