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The Victorian Cardiac Outcomes Registry (VCOR) Heart Failure Snapshot
Abstracts
S123
Conclusion: We recommend avoiding future pregnancies due to risk of recurrent PPCM and associated risk of morbidity and mortality with need for clear guidelines regarding management. http://dx.doi.org/10.1016/j.hlc.2016.06.291 291 The Victorian Cardiac Outcomes Registry (VCOR) Heart Failure Snapshot A. Driscoll 1,2,∗ , A. Brennan 1 , D. Dinh 1 , J. Lefkovits 1,3 , D. Hare 4 , H. Carruthers 1 , I. Hopper 1 , D. Kaye 5 , C. Neil 6 , D. Prior 7 , C. Reid 1,8 1 Monash
University, Melbourne, Australia University, Burwood, Australia 3 Royal Melbourne Hospital, Melbourne, Australia 4 The Austin Hospital, Heidelberg, Australia 5 The Alfred Hospital, Melbourne, Australia 6 Western Hospital, Footscray, Australia 7 St Vincent’s Hospital, Fitzroy, Australia 8 Curtin University, Perth, Australia 2 Deakin
Background: Heart failure confers a heavy burden on both patients and community resources. Evidence-based therapies can improve patient outcomes and their translation into clinical practice can be ensured through appropriate monitoring and measurement. Methods: The VCOR Heart Failure Snapshot prospectively recruited 289 patients admitted with acute decompensated heart failure (ADHF) across 13 regional and metropolitan hospitals. All patients were followed up at 30 days post-discharge to determine outcomes and compliance with evidence-based treatment. Results: The patients’ median age was 80 years (IQR 71-87 years) and 43% were female. In patients with heart failure with reduced ejection fraction (HFrEF), ACEI and beta-blocker usage increased from admission (ACEI 46% vs beta-blocker 59%) to discharge (ACEI 54% vs beta-blocker 82%). New diagnosis of heart failure HFrEF NYHA Class III-IV at admission 30-day readmission 30 day mortality
99 (34) 120 (42) 118 (41) 72 (26) 27 (9)
Of the patients that were readmitted, one third represented within 10 days post-discharge. Overall, 61% of patients were scheduled for an outpatient appointment at discharge, with 30% attending by day 30 post-discharge Conclusion: For ADHF, evidence-based drug therapies are under-utilised, while hospital readmission rates remain high. Rapid access to transitional care continues to be problematic. Improved acute treatment, and accessibility and processes of care for transitional care for heart failure patients must be a priority if outcomes are to be optimised. http://dx.doi.org/10.1016/j.hlc.2016.06.292
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292 Treatment Gap in Heart Failure with Reduced Ejection Fraction Patients: How Well are we Implementing Evidence-Based Care? K. Chin 1,2,∗ , M. Skiba 1,2 , A. Tonkin 1 , C. Reid 1,3 , D. Liew 1 , H. Krum 1,2 , I. Hopper 1,2 1 Centre
of Cardiovascular Research and Education in Therapeutics, Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia 2 Clinical Pharmacology Department, Alfred Hospital, Melbourne, Australia 3 School of Public Health, Curtin University, Perth, Australia Background: The extent and impact of under-prescribing of evidence-based pharmacological therapies among patients with heart failure with reduced ejection fraction (HFREF) in contemporary practice is unclear. Methods: A comprehensive search of the MEDLINE, PubMed, Embase, CINAHL and CENTRAL databases was performed. Studies were included if the registries or population-based surveys examined the prescribing rates of ACE inhibitors, ARBs, BBs and MRAs among patients with chronic SHF. Searches were limited to those published in the years 2000-2015 and in English. Sample-size weighted means and standard deviations were calculated for the baseline clinical characteristics, medical history and prescribing rates. Based on the recommendations in the contemporary practice guidelines, we examined the prescribed doses and estimated the treatment gap in the selected studies. Results: A total of 23 reports, including 83,605 patients, were evaluated. Overall, ACE inhibitors/ARBs, BBs and MRAs were prescribed to 79.8%, 81.4% and 36.4% of patients, respectively. The estimated treatment gaps in the overall population were 13.1% for ACE inhibitors/ARBs, 3.9% for BBs 16.8% and MRAs. The proportion of patients who received ≥50% of the guideline-recommended target doses was 72% for ACE inhibitors, 51% for ARBs, 49% for BBs, 53% for the combination of ACE inhibitors/ARBs and BBs and 83% for MRAs. Patients who were elderly, female and with comorbidities were less likely to receive optimal treatment as recommended by the guidelines. Conclusions: ACE inhibitors, ARBs, BBs and MRAs are under-prescribed in eligible patients with chronic SHF. http://dx.doi.org/10.1016/j.hlc.2016.06.293
S123
Conclusion: We recommend avoiding future pregnancies due to risk of recurrent PPCM and associated risk of morbidity and mortality with need for clear guidelines regarding management. http://dx.doi.org/10.1016/j.hlc.2016.06.291 291 The Victorian Cardiac Outcomes Registry (VCOR) Heart Failure Snapshot A. Driscoll 1,2,∗ , A. Brennan 1 , D. Dinh 1 , J. Lefkovits 1,3 , D. Hare 4 , H. Carruthers 1 , I. Hopper 1 , D. Kaye 5 , C. Neil 6 , D. Prior 7 , C. Reid 1,8 1 Monash
University, Melbourne, Australia University, Burwood, Australia 3 Royal Melbourne Hospital, Melbourne, Australia 4 The Austin Hospital, Heidelberg, Australia 5 The Alfred Hospital, Melbourne, Australia 6 Western Hospital, Footscray, Australia 7 St Vincent’s Hospital, Fitzroy, Australia 8 Curtin University, Perth, Australia 2 Deakin
Background: Heart failure confers a heavy burden on both patients and community resources. Evidence-based therapies can improve patient outcomes and their translation into clinical practice can be ensured through appropriate monitoring and measurement. Methods: The VCOR Heart Failure Snapshot prospectively recruited 289 patients admitted with acute decompensated heart failure (ADHF) across 13 regional and metropolitan hospitals. All patients were followed up at 30 days post-discharge to determine outcomes and compliance with evidence-based treatment. Results: The patients’ median age was 80 years (IQR 71-87 years) and 43% were female. In patients with heart failure with reduced ejection fraction (HFrEF), ACEI and beta-blocker usage increased from admission (ACEI 46% vs beta-blocker 59%) to discharge (ACEI 54% vs beta-blocker 82%). New diagnosis of heart failure HFrEF NYHA Class III-IV at admission 30-day readmission 30 day mortality
99 (34) 120 (42) 118 (41) 72 (26) 27 (9)
Of the patients that were readmitted, one third represented within 10 days post-discharge. Overall, 61% of patients were scheduled for an outpatient appointment at discharge, with 30% attending by day 30 post-discharge Conclusion: For ADHF, evidence-based drug therapies are under-utilised, while hospital readmission rates remain high. Rapid access to transitional care continues to be problematic. Improved acute treatment, and accessibility and processes of care for transitional care for heart failure patients must be a priority if outcomes are to be optimised. http://dx.doi.org/10.1016/j.hlc.2016.06.292
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
292 Treatment Gap in Heart Failure with Reduced Ejection Fraction Patients: How Well are we Implementing Evidence-Based Care? K. Chin 1,2,∗ , M. Skiba 1,2 , A. Tonkin 1 , C. Reid 1,3 , D. Liew 1 , H. Krum 1,2 , I. Hopper 1,2 1 Centre
of Cardiovascular Research and Education in Therapeutics, Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia 2 Clinical Pharmacology Department, Alfred Hospital, Melbourne, Australia 3 School of Public Health, Curtin University, Perth, Australia Background: The extent and impact of under-prescribing of evidence-based pharmacological therapies among patients with heart failure with reduced ejection fraction (HFREF) in contemporary practice is unclear. Methods: A comprehensive search of the MEDLINE, PubMed, Embase, CINAHL and CENTRAL databases was performed. Studies were included if the registries or population-based surveys examined the prescribing rates of ACE inhibitors, ARBs, BBs and MRAs among patients with chronic SHF. Searches were limited to those published in the years 2000-2015 and in English. Sample-size weighted means and standard deviations were calculated for the baseline clinical characteristics, medical history and prescribing rates. Based on the recommendations in the contemporary practice guidelines, we examined the prescribed doses and estimated the treatment gap in the selected studies. Results: A total of 23 reports, including 83,605 patients, were evaluated. Overall, ACE inhibitors/ARBs, BBs and MRAs were prescribed to 79.8%, 81.4% and 36.4% of patients, respectively. The estimated treatment gaps in the overall population were 13.1% for ACE inhibitors/ARBs, 3.9% for BBs 16.8% and MRAs. The proportion of patients who received ≥50% of the guideline-recommended target doses was 72% for ACE inhibitors, 51% for ARBs, 49% for BBs, 53% for the combination of ACE inhibitors/ARBs and BBs and 83% for MRAs. Patients who were elderly, female and with comorbidities were less likely to receive optimal treatment as recommended by the guidelines. Conclusions: ACE inhibitors, ARBs, BBs and MRAs are under-prescribed in eligible patients with chronic SHF. http://dx.doi.org/10.1016/j.hlc.2016.06.293