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Inflammatory Bowel Disease is Associated with Risk of Mortality and Hospitalization in Patients with Heart Failure
The 20th Annual Scientific Meeting
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HFSA
S95
274 Correlates of Health-Related Quality of Life in Patients with Hypertrophic Cardiomyopathy John L. Jefferies1, Ian Kudel2, Lisa Salberg3; 1CCHMC, Cincinnati, OH; 2Kantar Health, New York, NY; 3HCMA, Denville, NJ
276 Introduction: The link between demographic, clinical variables and health-related quality of life (HRQoL) in hypertrophic cardiomyopathy patients (HCM) is not well established. Hypothesis: Specific predictors of decreased HRQoL in HCM can be identified. Methods: The Hypertrophic Cardiomyopathy Association contacted members diagnosed with HCM by e-mail to complete an online (N = 712, completion rate 51.78%). They were given 2 weeks to complete the questionnaire and were sent 5 e-mail reminders. Demographic variables included sex, race, age, age of HCM onset. Medical variables include total number of types of heart surgeries, if a medical device had been implanted, total number of cardiomopathy (CM) medications being used, total number of distinct activities (ACT) that cause HCM symptoms, and total number of distinct CM symptoms (CMSx) experienced such as palpitations. HRQoL was measured using the total Peds-Ql score, which assesses function in 4 domains (physical, emotional, social, school/work). The total score (range 0–100; higher scored indicating greater HRQoL) was the dependent variable. A linear regression was modeled using Mplus 7.1. Results: The majority of respondents were Caucasian (N = 658, 93%), middle aged (M = 52.10, SD = 1.40), and composed of almost equal numbers of men and women (male = 347, 49%). The significant predictors (all P < .00) of the PedsQL was sex (Β = −.16), age (Β = −.13), total number of medications (Β = −.15), ACT (Β = −.32,), and CMSx (Β=-0.26,). The R2 = .36 and the effect size was 0.55. History of surgical procedures and/or the presence of a defibrillator were not significant predictors of decreased HRQoL. Conclusions: Our findings suggest that predictors of impaired HRQoL such as number of medications and symptoms related to activity and CM can be identified in HCM. Management strategies such as surgery or defibrillator implantation do not impact HRQoL. Assessment of these factors may offer providers an opportunity to identify areas of concern and implement management strategies to improve HRQoL in patients with HCM.
275 Utilization of Guideline Documented Medical Therapy in Patients with New Onset Heart Failure with Reduced Ejection Fraction: A Veteran’s Affairs Study Purvi J. Parwani, Mubasher Abbas, Huzair Ali, Pedro Lozano, Udho Thadani, Tarun Dasari; University of Oklahoma, Oklahoma City, OK Introduction:Utilization of maximal Guideline Documented Medical Therapy(GDMT) significantly reduce long-term mortality in patients with HFrEF (Heart Failure with reduced Ejection Fraction). Previous studies have documented underutilization of the GDMT in HFrEF. The aim of this study was to determine utilization and achievement of target doses of GDMT in patients with HFrEF. Methods: Patients presenting to the VA medical center with new onset HFrEF (Jan 2011–December 2013) were included in the analysis. Baseline demographic, clinical & echocardiographic data were collected. Utilization of GDMT at the time of the discharge and at 1,3,6 & 12 months during follow-up was assessed. Results: Of the 95 patients that presented with symptoms and signs suggestive of acute heart failure, 48 met the criteria for LVEF < 40% (baseline characteristics in Table). 44 (90%) were discharged on Beta-blockers while 38 (79%) were discharged on ACE inhibitors/ARB. A clinical follow-up with a healthcare provider occurred in 77% at 1 month, 52% at 3 months, 54% at 6 months and 58% at 1 year. Dose titration of either Beta-Blocker or ACEi/ARB was attempted in 42% at 1 month, 44% at 3 months, 27% at 6 months and 29% at 12 months. Reasons for underutilization of target doses of GDMT are listed in Table 2. Conclusion: Utilization and achievement of target doses of GDMT was suboptimal among patients discharged with newly diagnosed HFrEF during a 1 year follow up. Concerted efforts need to be made to further improve adherence to target doses of GDMT in patients with HFrEF.
Inflammatory Bowel Disease is Associated with Risk of Mortality and Hospitalization in Patients with Heart Failure Daniel W. Hugenberg, Marc Rosenman, Yaron Hellman, Azam Hadi; Indiana University School of Medicine, Indianapolis, IN Introduction: The purpose of this study is to assess the association between inflammatory bowel disease (IBD) and heart failure (HF) in terms of HF prevalence, mortality, heart transplantation/ventricular assist device (VAD) implantation, and hospitalizations. Methods: The data in this study were extracted from the Indiana Network for Patient Care (INPC) database, a healthcare information exchange which is used in clinical applications and in research. With the aid of the Regenstrief Institute, data for IBD (Crohn Disease and Ulcerative Colitis) and HF were retrospectively collected based on ICD-9 diagnosis codes, for patients age 18 years or older from 2002–2011. We identified 12,073 patients with IBD who were age-matched with 12,073 control cases. The index date for case and control was defined by the case’s first IBD diagnosis code during the study period. Patient data including mortality, hospitalizations, etc. from two years before and after the index date were analyzed. Results: The prevalence of HF in the IBD group was 4.08% compared to 6.64% in the control group (RR 0.61, 95% CI 0.55–0.68, P < .001). The overall mortality difference was not significant, i.e., 6.58% in the IBD group and 6.51% in the control group (RR 1.01, 95% CI 0.92–1.11, P = .815). Mortality was significantly higher for patients with HF and IBD, i.e., 29.20% compared to 23.32% for patients with HF in the control group (RR 1.25, 95% CI 1.04–1.51, P = .018). There was no difference in the rate of heart transplantation and VAD implantation between any of the groups. Before the index date (date of first IBD diagnosis), the number of patients requiring hospitalization was significantly higher, i.e., 64.10% (316/493) in the IBD/HF group compared to 35.00% (281/803) of patients with HF in the control group (RR 1.83, 95% CI 1.63–2.06, P < .001). After the index date, the number of patients requiring hospitalization was markedly higher, i.e., 82.76% (408/493) in the IBD/HF group compared to 35.74% (287/803) in the patients with HF in the control group (RR 2.32, 95% CI 2.09–2.56, P < .001). There was no change in the number of patients hospitalized before or after the index date in patients with HF in the control group (RR 1.02, 95% CI 0.89–1.17, P = .754). In the IBD/ HF group, there was a significant increase in the number of patients requiring hospitalization after the index date (RR 1.29, 95% CI 1.19–1.40, P < .001). Conclusions: Patients with HF and IBD are at increased risk of mortality and hospitalization compared to patients with HF alone. The prevalence of HF is lower in patients with IBD compared to the general population.
•
HFSA
S95
274 Correlates of Health-Related Quality of Life in Patients with Hypertrophic Cardiomyopathy John L. Jefferies1, Ian Kudel2, Lisa Salberg3; 1CCHMC, Cincinnati, OH; 2Kantar Health, New York, NY; 3HCMA, Denville, NJ
276 Introduction: The link between demographic, clinical variables and health-related quality of life (HRQoL) in hypertrophic cardiomyopathy patients (HCM) is not well established. Hypothesis: Specific predictors of decreased HRQoL in HCM can be identified. Methods: The Hypertrophic Cardiomyopathy Association contacted members diagnosed with HCM by e-mail to complete an online (N = 712, completion rate 51.78%). They were given 2 weeks to complete the questionnaire and were sent 5 e-mail reminders. Demographic variables included sex, race, age, age of HCM onset. Medical variables include total number of types of heart surgeries, if a medical device had been implanted, total number of cardiomopathy (CM) medications being used, total number of distinct activities (ACT) that cause HCM symptoms, and total number of distinct CM symptoms (CMSx) experienced such as palpitations. HRQoL was measured using the total Peds-Ql score, which assesses function in 4 domains (physical, emotional, social, school/work). The total score (range 0–100; higher scored indicating greater HRQoL) was the dependent variable. A linear regression was modeled using Mplus 7.1. Results: The majority of respondents were Caucasian (N = 658, 93%), middle aged (M = 52.10, SD = 1.40), and composed of almost equal numbers of men and women (male = 347, 49%). The significant predictors (all P < .00) of the PedsQL was sex (Β = −.16), age (Β = −.13), total number of medications (Β = −.15), ACT (Β = −.32,), and CMSx (Β=-0.26,). The R2 = .36 and the effect size was 0.55. History of surgical procedures and/or the presence of a defibrillator were not significant predictors of decreased HRQoL. Conclusions: Our findings suggest that predictors of impaired HRQoL such as number of medications and symptoms related to activity and CM can be identified in HCM. Management strategies such as surgery or defibrillator implantation do not impact HRQoL. Assessment of these factors may offer providers an opportunity to identify areas of concern and implement management strategies to improve HRQoL in patients with HCM.
275 Utilization of Guideline Documented Medical Therapy in Patients with New Onset Heart Failure with Reduced Ejection Fraction: A Veteran’s Affairs Study Purvi J. Parwani, Mubasher Abbas, Huzair Ali, Pedro Lozano, Udho Thadani, Tarun Dasari; University of Oklahoma, Oklahoma City, OK Introduction:Utilization of maximal Guideline Documented Medical Therapy(GDMT) significantly reduce long-term mortality in patients with HFrEF (Heart Failure with reduced Ejection Fraction). Previous studies have documented underutilization of the GDMT in HFrEF. The aim of this study was to determine utilization and achievement of target doses of GDMT in patients with HFrEF. Methods: Patients presenting to the VA medical center with new onset HFrEF (Jan 2011–December 2013) were included in the analysis. Baseline demographic, clinical & echocardiographic data were collected. Utilization of GDMT at the time of the discharge and at 1,3,6 & 12 months during follow-up was assessed. Results: Of the 95 patients that presented with symptoms and signs suggestive of acute heart failure, 48 met the criteria for LVEF < 40% (baseline characteristics in Table). 44 (90%) were discharged on Beta-blockers while 38 (79%) were discharged on ACE inhibitors/ARB. A clinical follow-up with a healthcare provider occurred in 77% at 1 month, 52% at 3 months, 54% at 6 months and 58% at 1 year. Dose titration of either Beta-Blocker or ACEi/ARB was attempted in 42% at 1 month, 44% at 3 months, 27% at 6 months and 29% at 12 months. Reasons for underutilization of target doses of GDMT are listed in Table 2. Conclusion: Utilization and achievement of target doses of GDMT was suboptimal among patients discharged with newly diagnosed HFrEF during a 1 year follow up. Concerted efforts need to be made to further improve adherence to target doses of GDMT in patients with HFrEF.
Inflammatory Bowel Disease is Associated with Risk of Mortality and Hospitalization in Patients with Heart Failure Daniel W. Hugenberg, Marc Rosenman, Yaron Hellman, Azam Hadi; Indiana University School of Medicine, Indianapolis, IN Introduction: The purpose of this study is to assess the association between inflammatory bowel disease (IBD) and heart failure (HF) in terms of HF prevalence, mortality, heart transplantation/ventricular assist device (VAD) implantation, and hospitalizations. Methods: The data in this study were extracted from the Indiana Network for Patient Care (INPC) database, a healthcare information exchange which is used in clinical applications and in research. With the aid of the Regenstrief Institute, data for IBD (Crohn Disease and Ulcerative Colitis) and HF were retrospectively collected based on ICD-9 diagnosis codes, for patients age 18 years or older from 2002–2011. We identified 12,073 patients with IBD who were age-matched with 12,073 control cases. The index date for case and control was defined by the case’s first IBD diagnosis code during the study period. Patient data including mortality, hospitalizations, etc. from two years before and after the index date were analyzed. Results: The prevalence of HF in the IBD group was 4.08% compared to 6.64% in the control group (RR 0.61, 95% CI 0.55–0.68, P < .001). The overall mortality difference was not significant, i.e., 6.58% in the IBD group and 6.51% in the control group (RR 1.01, 95% CI 0.92–1.11, P = .815). Mortality was significantly higher for patients with HF and IBD, i.e., 29.20% compared to 23.32% for patients with HF in the control group (RR 1.25, 95% CI 1.04–1.51, P = .018). There was no difference in the rate of heart transplantation and VAD implantation between any of the groups. Before the index date (date of first IBD diagnosis), the number of patients requiring hospitalization was significantly higher, i.e., 64.10% (316/493) in the IBD/HF group compared to 35.00% (281/803) of patients with HF in the control group (RR 1.83, 95% CI 1.63–2.06, P < .001). After the index date, the number of patients requiring hospitalization was markedly higher, i.e., 82.76% (408/493) in the IBD/HF group compared to 35.74% (287/803) in the patients with HF in the control group (RR 2.32, 95% CI 2.09–2.56, P < .001). There was no change in the number of patients hospitalized before or after the index date in patients with HF in the control group (RR 1.02, 95% CI 0.89–1.17, P = .754). In the IBD/ HF group, there was a significant increase in the number of patients requiring hospitalization after the index date (RR 1.29, 95% CI 1.19–1.40, P < .001). Conclusions: Patients with HF and IBD are at increased risk of mortality and hospitalization compared to patients with HF alone. The prevalence of HF is lower in patients with IBD compared to the general population.