Incidence, Predictors, and Implications of Re-Hospitalization for Heart Failure after Acute Myocardial Infarction

Incidence, Predictors, and Implications of Re-Hospitalization for Heart Failure after Acute Myocardial Infarction

The 23rd Annual Scientific Meeting  HFSA fold increased odds of in-hospital mortality relative to patients with HCM without PHTN. As the risk of sudd...

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The 23rd Annual Scientific Meeting  HFSA fold increased odds of in-hospital mortality relative to patients with HCM without PHTN. As the risk of sudden cardiac death in HCM declines related to the success of primary prevention, the complications of advanced heart failure and PHTNrelated morbidity and mortality must be recognized.

Table 1. Admission Characteristics of Hypertrophic Cardiomyopathy Patients with and without Pulmonary Hypertension

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adjudicated as directly related to the myocardial re-infarction. By multivariable analysis, the independent predictors of rHHF at 2-year follow-up were age (older); gender (female); previous HF; acute HF (Killip classification 2); lower baseline estimated glomerular filtration rate and left ventricular ejection fraction; anterior AMI as culprit location; multivessel disease; and major bleeding and acute kidney injury during index hospitalization. Percutaneous coronary intervention as principal management strategy and discharge use of renin angiotensin aldosterone system blocker carried significant low incidence of rHHF. However, b-blockers at discharge were not associated with rHHF at 2-year follow-up. In a time-adjusted multivariable analysis, rHHF was a significant independent predictor of myocardial re-infarction (adjusted hazard ratio [HR] 3.008 [2.099-4.310]), any repeat revascularisation (adjusted HR 2.484 [1.187-5.200]), and stent thrombosis (adjusted HR 3.352 [1.623-6.925]); and a borderline predictor of cardiac death but did not reach statistical significance (adjusted HR 1.390 [0.964-2.004], p=0.078). Conclusions: In the nationwide AMI registry, rHHF within 2 years after AMI occurred in 4.0% of patients, with 60.8% within 6 months. Several baseline and procedural factors were identified as independent predictors of rHHF. An rHHF was strongly associated with subsequent adverse clinical outcomes, and therefore, strategies to identify and treat the risk factors for post-AMI rHHF should be implemented to prevent this devastating complication.

419 Representativeness of the PIONEER-HF Clinical Trial Population in Patients Hospitalized with Heart Failure Sabina Sayeed1, Marat Fudim2, Haolin Xu2, Roland Matsouaka2, Paul A. Heidenreich3, Clyde W. Yancy4, Gregg C. Fonarow5, Eric J. Velazquez6, Adrian F. Hernandez2, Adam D. DeVore2; 1Duke Clinical Research Institute, Durham, NC; 2 Duke University, Durham, NC; 3Veterans Affairs Palo Alto, Palo Alto, CA; 4Northwestern University, Chicago, IL; 5University of California, Los Angeles Medical Center, Los Angeles, CA; 6Yale University School of Medicine, New Haven, CT

Table 2. Multivariable Analysis of Factors Associated with in-Hospital Mortality

Introduction: In the PIONEER-HF trial, the in-hospital initiation of sacubitril/valsartan in patients hospitalized for acute decompensated heart failure (ADHF) was welltolerated and led to a greater reduction in N-terminal pro-B natriuretic peptide compared with enalapril, and reduced HF hospitalizations. In this study, we aimed to: (1) determine eligibility for the PIONEER-HF trial among patients in a contemporary registry population with ADHF and HF with reduced ejection fraction (”all HFrEF”), (2) determine eligibility for sacubitril/valsartan using criteria most relevant to daily clinical practice (“actionable” cohort), and (3) compare long-term outcomes between the all HFrEF, PIONEER-HF trial eligible, and actionable cohorts using linked Medicare claims data. Methods: The initial study population was derived from all patients discharged alive in the Get With The Guidelines-HF(GWTG-HF) registry between January 2006 and June 2018 with a left ventricular ejection fraction 40%. We derived cohorts meeting PIONEER-HF trial eligibility criteria and a set of clinically relevant criteria. Rates of HF-readmissions and all-cause mortality 1-year post index discharge were obtained linking the GWTG-HF registry with Medicare fee-for-service claims. Results: Total of 99,767 patients in GWTG-HF were hospitalized for ADHF and HFrEF. PIONEER-HF inclusion criteria were met by 71,633 (71.8%) patients, and both inclusion and exclusion criteria were met by 20,704 (20.8%). 68,739 (68.9%) patients met the criteria for the actionable cohort (Figure). Among the CMSlinked patients, the 1-year all-cause mortality was 36.7% for all HFrEF patients, 32.2% for the actionable cohort and 31.6% for the PIONEER-HF trial eligible cohort (Log rank test P <0.001). The HF rehospitalization rate at 1 year was 35.1% for all HFrEF patients, 33.1% for the actionable cohort and 32.6% for the PIONEER-HF trial eligible cohort (Gray’s test P <0.001). Conclusions: Patient characteristics and clinical outcomes in participants enrolled in PIONEERHF only modestly differ compared with those encountered in routine practice, suggesting the findings of this trial may be broadly generalizable.

418 Incidence, Predictors, and Implications of Re-Hospitalization for Heart Failure after Acute Myocardial Infarction Pil-Sang Song1, Myung Ho Jeong2; 1Mediplex Sejong General Hospital, Incheon, Republic of Korea; 2Chonnam National University College of Medicine, Gwangju, Republic of Korea Background: Patients who survive an index acute myocardial infarction (AMI) are at an increased risk for future cardiovascular events. However, there have been few studies about re-hospitalization for heart failure (rHHF) after AMI in an unselected group of patients. Hypothesis: To explore the incidence, predictors, and subsequent clinical outcomes of post-AMI rHHF from nationwide AMI registry. Methods: The study population consisted of 13,104 patients admitted for an index AMI between Nov. 2011 and Dec. 2015. The index in-hospital mortality rate was 3.85%, and these patients were excluded from the subsequent analysis, leaving 12,600 patients in the study cohort. Results: A total of 510 rHHF (4.0%) had occurred in 444 patients during median 732 (696-760) days follow-up; 382 (86.0%) were re-hospitalized once and 62 (14.0%) were re-hospitalized 2 times. The median time to first rHHF was 123 (42-335) days. An rHHF occurred in in 270 patients (60.8%) within 6 months; the incidence of rHHF steadily increased thereafter, with 174 more patients (39.2%) having an rHHF between 6 months and 2 years. Among 444 patients with rHHF, 42 (9.5%) patients were

Figure. Representativeness of the PIONEER HF Trial Population in a Contemporary Patient Sample.