European Heart Journal - Quality of Care and Clinical Outcomes最新文献

{"title":"Patterns of comorbidities, clinical course, and impact of the ABC Pathway for Integrated Care in patients with atrial fibrillation: a report from the prospective Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) Registry.","authors":"Marta Mantovani, Tommaso Bucci, Jacopo F Imberti, Steven H M Lam, Agnieszka Kotalczyk, Giuseppe Boriani, Yutao Guo, Gregory Y H Lip","doi":"10.1093/ehjqcco/qcaf014","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf014","url":null,"abstract":"<p><strong>Aims: </strong>To identify comorbidities patterns in elderly Chinese patients with atrial fibrillation (AF), their clinical course, and the effectiveness of the Atrial fibrillation Better Care (ABC) pathway adherence among these phenotypes.</p><p><strong>Methods: </strong>From the ChiOTEAF Registry, we performed a latent class analysis based on 16 cardiovascular (CV) and non-CV conditions. The association between classes of patients, management, and outcomes was evaluated. The primary outcome was a composite of all-cause death and major adverse cardiovascular events. We assessed the impact of ABC adherence on outcomes in the whole cohort and among phenotypes.</p><p><strong>Results: </strong>We included 4765 AF patients (median age 77 [68-83] years, 39.1% females). Four phenotypes were identified: (1) Low complexity (48.9%); (2) Atherosclerotic (19.3%); (3) Heart failure (19.4%); and (4) High complexity (12.3%).During a 1-year follow-up, compared to the 'low complexity' class, the risk of adverse events was higher in 'high complexity' (aOR, 95% CI: 3.20, 2.21-4.66) and 'heart failure' classes (aOR, 95% CI: 1.50, 1.04-2.17).Among 2654 patients (median age 75 [66-81] years, 43.3% females) with available information to assess the ABC pathway, 1094 (41.2%) were adherent. ABC pathway adherence was associated with a lower risk (aOR, 95% CI: 0.37, 0.20-0.65). On interaction analysis, its beneficial effect was similar across different clinical phenotypes (Pint = 0.122).</p><p><strong>Conclusion: </strong>Different clinical phenotypes can be identified in Asian AF patients, with specific patterns of comorbidities and different risks of adverse events. Full ABC pathway adherence was associated with improved outcomes, regardless of the clinical phenotype.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics, use of guideline-recommended medical therapies and clinical outcomes of patients with heart failure not enrolled in a quality registry: A comparison with the Swedish Heart Failure Registry.","authors":"Ailema González-Ortiz, Paul Hjemdahl, Faizan Mazhar, Alessandro Bosi, Anne-Laure Faucon, Gianluigi Savarese, Lars H Lund, Juan Jesus Carrero","doi":"10.1093/ehjqcco/qcaf019","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf019","url":null,"abstract":"<p><strong>Introduction: </strong>Quality registries may involve specific inclusion criteria, detailed investigations or selected hospitals and practitioners, which are not random. Whether the care and outcomes in quality registries are generalizable to the broader population is not well known. We here examine care indicators and outcomes in heart failure (HF) patients enrolled vs. non-enrolled in Swedish Heart Failure (SwedeHF) quality registry.</p><p><strong>Methods: </strong>Observational study of 90-day survivors after a HF in Stockholm (2012-2021). We linked health records from the Stockholm Creatinine Measurements (SCREAM) project with SwedeHF. Participants enrolled in SwedeHF were compared to those non-enrolled, focusing on settings of care, use of guideline-recommended therapies, treatment adherence, dose titration, persistence, and outcomes. Analyses considered stratification by settings of management (primary care, cardiology-outpatient and cardiology-inpatient care).</p><p><strong>Results: </strong>We identified 48,374 incident HF cases of which 4,878 (10%) were enrolled in SwedeHF within 90 days. Enrolled participants were younger, more often men and had fewer comorbidities than non-enrolled. Enrolled participants were more likely to initiate, persist and adhere to, and achieve higher dosages of guideline-recommended HF therapies (P<0.05 for all). Enrolled participants were less likely to experience a major cardiovascular event (CV death, nonfatal myocardial infarction or stroke; HR 0.92, 95% CI 0.86-0.99) and all-cause death (HR 0.87, 95% CI 0.82-0.92), but had similar rates of HF hospitalization (HR 1.03, 95% CI 0.94-1.15) compared to non-enrolled ones. Findings were similar across settings of management.</p><p><strong>Conclusion: </strong>Enrollment in the SwedeHF registry occurred in a minority of patients, and was associated with better adherence to guideline-recommended heart failure therapies and fewer major cardiovascular events and lower mortality. The generalizability of these HF registry findings to all HF patients was, however, limited.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specialist services for cardiomyopathy: quality care requires diagnostic accuracy.","authors":"Anna Cantone, Saidi A Mohiddin, Massimiliano Lorenzini","doi":"10.1093/ehjqcco/qcae044","DOIUrl":"10.1093/ehjqcco/qcae044","url":null,"abstract":"","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusion and reporting by age, sex, and ethnicity in clinical studies of high-risk medical devices approved in the European Union.","authors":"J J Coughlan, R A Byrne, G C M Siontis, L McGovern, R Durand, A Lübbeke, A Bano, A G Fraser","doi":"10.1093/ehjqcco/qcaf007","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf007","url":null,"abstract":"<p><strong>Introduction: </strong>Adequate inclusion and representation of patients in clinical studies is critical for the generalizability of research findings. The aim of this analysis was to determine inclusion and reporting by age, sex and ethnicity in clinical studies of high-risk medical devices (orthopaedic, diabetes and cardiovascular) approved in the European Union (EU).</p><p><strong>Methods: </strong>This is an analysis of data from three co-ordinated systematic reviews of clinical evidence for high-risk medical devices. This analysis includes 641 studies, reporting on more than 1.9 million patients treated with high risk orthopaedic, diabetes and cardiovascular medical devices. The main outcomes were the proportions of studies providing data on the age, sex and ethnicity of participants, and the performance of stratified analyses based on these factors.</p><p><strong>Results: </strong>The majority (>90%) of studies in all three device categories (orthopaedics, diabetes and cardiovascular) provided data on the age and sex of participants, but only a minority (<10%) provided information on ethnicity. Female patients comprised over half of patients in the included orthopaedic and diabetes device studies, but less than 40% of patients in the included cardiovascular device studies (p < 0.001). A minority of studies performed analyses stratified by age (14.6%) or sex (10.4%), although those were more frequently reported in randomized studies.</p><p><strong>Conclusions: </strong>Almost all studies in this analysis provided demographic data on age and sex, but only a small minority had analysed if these factors had any impact on device performance. Very few studies provided information on the ethnicity of study participants. Cardiovascular device studies enrolled a lower proportion of female patients in comparison to orthopaedic and diabetes device studies. Study registration Cardiovascular device systematic review: PROSPERO (CRD42022308593, Diabetes device systematic review: PROSPERO (CRD42022366871). Orthopaedic device systematic review: open science framework (https://osf.io/6gmyx).</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic evaluation of the Liverpool heart failure virtual ward model.","authors":"Debar Rasoul, Ipsita Chattopadhyay, Tony Mayer, Jenni West, Hadleigh Stollar, Casey Black, Emeka Oguguo, Rosie Kaur, Rachael MacDonald, Jessica Pocock, Barbara Uzdzinska, Bethany Umpleby, Nick Hex, Gregory Yoke Hong Lip, Rajiv Sankaranarayanan","doi":"10.1093/ehjqcco/qcae095","DOIUrl":"10.1093/ehjqcco/qcae095","url":null,"abstract":"<p><strong>Background: </strong>A virtual ward (VW) supports patients who would otherwise need hospitalization by providing acute care, remote monitoring, investigations, and treatment at home. By March 2024, the VW programme had treated 10 950 patients across six speciality VWs, including heart failure (HF). This evaluation presents the economic assessment of the Liverpool HF VW.</p><p><strong>Method and results: </strong>A comprehensive economic cost comparison model was developed by the York Health Economics Consortium (University of York) to compare the costs of the VW to standard hospital inpatient care [standard care (SC)]. The model included direct VW costs and additional costs across the care pathway. Costs and resource use for 648 patients admitted to the HF VW were calculated for 30 days post-discharge and total cohort costs were extrapolated to a full year. Primary outcomes included costs related to length of stay, readmissions, and NHS 111 contact. The total cost for the HF VW pathway, including set-up costs, was £467 524. This results in an incremental net cost benefit of £735 512 compared with the total SC cost of £1 203 036, indicating a substantial net cost benefit of £1135 per patient per episode (PPPE). This advantage remains despite initial setup expenses and ongoing costs such as home visits, virtual consultations, point-of-care testing, and home monitoring equipment.</p><p><strong>Conclusion: </strong>Our HF VW model offers a substantial net cost benefit, driven by reduced hospital stays, fewer emergency department visits, and lower readmission rates. The study highlights the importance of considering system-wide impacts and continuous monitoring of VWs as they develop.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"197-205"},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden and trends of heart failure caused by ischaemic heart disease at the global, regional, and national levels from 1990 to 2021.","authors":"Hongwei Zhang, Xiaoyu Zheng, Pingping Huang, Lijun Guo, Yuan Zheng, Dawu Zhang, Xiaochang Ma","doi":"10.1093/ehjqcco/qcae094","DOIUrl":"10.1093/ehjqcco/qcae094","url":null,"abstract":"<p><strong>Background: </strong>Ischaemic heart disease (IHD) is a major cause of heart failure (HF), a condition expected to increasingly affect global health and economics. This study evaluates the global burden, trends, and disparities of HF linked to IHD, aiming to inform health policy development.</p><p><strong>Methods and results: </strong>Data from the Global Burden of Disease Study 2021 (GBD2021) are analysed using joinpoint regression, decomposition analysis, and Bayesian age-period-cohort analysis (BAPC). Health disparities are assessed through the Socio-demographic Index (SDI) via the Slope Index of Inequality and the Concentration Index, with future trends projected from 2022 to 2045. In 2021, global HF cases due to IHD were over 19.16 million, with an age-standardized prevalence rate (ASPR) of 228.31 per 100 000 [95% Uncertainty Interval (UI), 188.18-279.55] and age-standardized years lived with disability (ASYLDs) rate of 20.43 per 100 000 [95% UI, 13.55-28.7]. In 2021, there was a 2.87% increase in ASPR and ASYLDs compared with 1990, primarily driven by population growth and aging. Significant reductions in global ASPR and ASYLDs disparities are observed, though the disease burden has intensified in countries with lower SDI levels. Projections indicate that by 2045, while the prevalence and years lived with disability for HF caused by IHD will increase, the ASPR and ASYLDs are expected to decrease.</p><p><strong>Conclusion: </strong>The global burden of HF due to IHD remains a significant concern. Urgent improvements in the allocation of medical resources and the implementation of effective prevention and management strategies are necessary to address this issue.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"186-196"},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National health expenditure per capita is associated with CRT implantation practice: findings from the ESC CRT Survey II with 11 088 patients.","authors":"Camilla Normand, Nigussie Bogale, Cecilia Linde, Stelios Tsintzos, Zenichi Ihara, Kenneth Dickstein","doi":"10.1093/ehjqcco/qcae082","DOIUrl":"10.1093/ehjqcco/qcae082","url":null,"abstract":"<p><strong>Aims: </strong>Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in selected patients with heart failure (HF) and electrical dyssynchrony. This treatment receives class IA recommendations in European Society of Cardiology (ESC) guidelines. However, despite these strong recommendations, CRT implantation practice varies greatly in Europe. The purpose of the sub-analysis of CRT Survey II data was to describe how countries' health per capita expenditure affects CRT implantation practice.</p><p><strong>Methods and results: </strong>Between 2015 and 2016, two ESC associations, European Heart Rhythm Association and Heart Failure Association, conducted the CRT Survey II, a survey of CRT implantations in 11 088 patients in 42 ESC member states. We analysed CRT patient selection and guideline adherence in those countries according to high or low health expenditure per capita. There were 21 high health expenditure countries (n = 6844 patients) and 21 (n = 3852) with low health expenditure. The countries with the lowest health expenditure were more likely to implant CRT in patients who had strong guideline recommendations for implantation, younger patients and those recently hospitalized for HF or with symptomatic HF (67% vs. 58%, P < 0.001). The ratio of CRT-Pacemaker (CRT-P) to CRT-Defibrillator (CRT-D) was similar in both spending groups, as was the percentage of CRT implantation in women.</p><p><strong>Conclusion: </strong>CRT Survey II has demonstrated a non-uniform delivery of healthcare. Countries with low health expenditure per capita appear to be reserving CRT therapy for younger patients, those with class IA indication and patients with more severe symptoms of heart failure.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"160-165"},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiling heart failure with preserved or mildly reduced ejection fraction by cluster analysis.","authors":"Lourdes Vicent, Nicolás Rosillo, Jorge Vélez, Guillermo Moreno, Pablo Pérez, José Luis Bernal, Germán Seara, Rafael Salguero-Bodes, Fernando Arribas, Héctor Bueno","doi":"10.1093/ehjqcco/qcae067","DOIUrl":"10.1093/ehjqcco/qcae067","url":null,"abstract":"<p><strong>Background: </strong>Significant knowledge gaps remain regarding the heterogeneity of heart failure (HF) phenotypes, particularly among patients with preserved or mildly reduced left ventricular ejection fraction (HFp/mrEF). Our aim was to identify HF subtypes within the HFp/mrEF population.</p><p><strong>Methods: </strong>K-prototypes clustering algorithm was used to identify different HF phenotypes in a cohort of 2570 patients diagnosed with heart failure with mildly reduced ejection fraction or heart failure with preserved left ventricular ejection fraction. This algorithm employs the k-means algorithm for quantitative variables and k-modes for qualitative variables.</p><p><strong>Results: </strong>We identified three distinct phenotypic clusters: Cluster A (n = 850, 33.1%), characterized by a predominance of women with low comorbidity burden; Cluster B (n = 830, 32.3%), mainly women with diabetes mellitus and high comorbidity; and Cluster C (n = 890, 34.5%), primarily men with a history of active smoking and respiratory comorbidities. Significant differences were observed in baseline characteristics and 1-year mortality rates across the clusters: 18% for Cluster A, 33% for Cluster B, and 26.4% for Cluster C (P < 0.001). Cluster B had the shortest median time to death (90 days), followed by Clusters C (99 days) and A (144 days) (P < 0.001). Stratified Cox regression analysis identified age, cancer, respiratory failure, and laboratory parameters as predictors of mortality.</p><p><strong>Conclusion: </strong>Cluster analysis identified three distinct phenotypes within the HFp/mrEF population, highlighting significant heterogeneity in clinical profiles and prognostic implications. Women were classified into two distinct phenotypes: low-risk women and diabetic women with high mortality rates, while men had a more uniform profile with a higher prevalence of respiratory disease.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"140-148"},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loss of quality of life and increased societal costs in patients with hypertrophic cardiomyopathy: the AFFECT-HCM study.","authors":"Stephan A C Schoonvelde, Isabell Wiethoff, Peter-Paul Zwetsloot, Alexander Hirsch, Christian Knackstedt, Tjeerd Germans, Maurits Sikking, Arend F L Schinkel, Marjon A van Slegtenhorst, Judith M A Verhagen, Rudolf A de Boer, Silvia M A A Evers, Mickaël Hiligsmann, Michelle Michels","doi":"10.1093/ehjqcco/qcae092","DOIUrl":"10.1093/ehjqcco/qcae092","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited cardiac disease. The impact of HCM on quality of life (QoL) and societal costs remains poorly understood. This prospective multi-centre burden of disease study estimated QoL and societal costs of genotyped HCM patients and genotype-positive phenotype-negative (G+/P-) subjects.</p><p><strong>Methods and results: </strong>Participants were categorized into three groups based on genotype and phenotype: (i) G+/P- [left ventricular (LV) wall thickness <13 mm], (ii) non-obstructive HCM [nHCM, LV outflow tract (LVOT) gradient <30 mmHg], and (iii) obstructive HCM (oHCM, LVOT gradient ≥30 mmHg). We assessed QoL with EQ-5D-5L and Kansas City Cardiomyopathy Questionnaires (KCCQ). Societal costs were measured using medical consumption (Medical Consumption Questionnaire) and productivity cost (iMTA Productivity Cost Questionnaire) questionnaires. We performed subanalyses within three age groups: <40, 40-59, and ≥60 years. From three Dutch hospitals, 506 subjects were enrolled (84 G+/P-, 313 nHCM, 109 oHCM; median age 59 years, 39% female). HCM (both nHCM and oHCM) patients reported reduced QoL vs. G+/P- subjects (KCCQ: 88 vs. 98, EQ-5D-5L: 0.88 vs. 0.96; both P < 0.001). oHCM patients reported lower KCCQ scores than nHCM patients (83 vs. 89, P = 0.036). Societal costs were significantly higher in HCM patients (€19,035/year vs. €7385/year) compared with G+/P- controls, mainly explained by higher healthcare costs and productivity losses. Being symptomatic and of younger age (<60 years) particularly led to decreased QoL and increased costs.</p><p><strong>Conclusion: </strong>HCM is associated with decreased QoL and increased societal costs, especially in younger and symptomatic patients. oHCM patients were more frequently symptomatic than nHCM patients. This study highlights the substantial disease burden of HCM and can aid in assessing new therapy cost-effectiveness for HCM in the future.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"174-185"},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicoeconomic burden among heart failure patients with severely reduced ejection fraction after hospital admission: HF-RESTORE.","authors":"Heidi T May, Jeffrey L Anderson, Michael Butzner, Punag H Divanji, Joseph B Muhlestein","doi":"10.1093/ehjqcco/qcae081","DOIUrl":"10.1093/ehjqcco/qcae081","url":null,"abstract":"<p><strong>Background: </strong>An estimated two-thirds of heart failure (HF) patients with reduced ejection fraction (HFrEF) hospitalized in the United States have a severely reduced left ventricular ejection fraction (LVEF <30%). Few studies have categorized patients according to their severity of left ventricular dysfunction beyond an LVEF of <30%.</p><p><strong>Methods and results: </strong>Intermountain Health patients (≥18 years) with a primary HF diagnosis, more than or equal to 1 inpatient hospitalization with a primary discharge diagnosis of HF, a documented LVEF of <30%, and a B-type natriuretic peptide >100 pg/mL within 1 year of hospitalization were studied. Patients were stratified by LVEF levels (≤15%, 16-25%, and 26-29%) and evaluated for death, HF hospitalization, healthcare resource utilization, and medical costs. Overall, 2184 patients (mean age 64.2 ± 15.5 years, 72.5% male) were stratified by LVEF [≤15%, n = 468 (21.4%); 16-25%, n = 1399 (64.1%); and 26-29%, n = 317 (14.5%)]. Lower LVEF was associated with younger age, male sex, and fewer comorbidities. Although 1-year mortality differed significantly between LVEF stratifications, which remained after adjustment by risk factors [vs. LVEF 26-29% (referent): ≤15%, hazard ratio (HR) = 1.92, P < 0.0001; and 16-25%, HR = 1.42, P = 0.01], mortality was similar by 3 years. HF hospitalizations at 1 and 3 years were similar among LVEF groups. Total HF costs-driven by increased HF outpatient costs-were significantly higher among LVEF of ≤15%.</p><p><strong>Conclusion: </strong>Patients with an LVEF of ≤15% had a modestly increased risk of 1-year mortality, as well as significantly higher total HF costs. Patients with HFrEF and a severely reduced LVEF continue to face an increased clinicoeconomic burden, and novel therapies to treat this unmet medical need are warranted.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"149-159"},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}