Comparison of Medication Practices in Patients with Heart Failure and Preserved vs those with Reduced Ejection Fraction (from the Cardiovascular Research Network)

摘要

Limited data exist describing differences in the medical management of patients with heart failure with preserved ejection fraction (HF-PEF) from those with heart failure with reduced ejection fraction (HF-REF) in more generalizable population-based cohorts. We studied individuals with incident HF diagnosed between 2005 and 2008 from 4 sites participating in the Cardiovascular Research Network. These persons, their medication profile, and left ventricular systolic function status were identified based on hospital discharge and ambulatory visit diagnoses, pharmacy dispensing information, and imaging reports found in health plan electronic databases and through chart review. The study population consisted of 6,210 patients with newly diagnosed HF-PEF and 3,914 patients with newly diagnosed HF-REF. The mean age of our study population was 73 years, 48% were women, and 74% were Caucasian. Patients with HF-REF were less likely to have been treated with various cardiac and HF related medications prior to their index HF event, but were significantly more likely to have been treated with new cardiac medications and HF therapies after the diagnosis of HF, than patients with HF-PEF. After controlling for several potentially confounding factors, patients with HF-PEF were significantly less likely to have been treated with multiple cardiac drug regimens (adjusted odds ratio (OR) = 0.69; 95% CI 0.59, 0.81) and multiple HF related therapies (OR = 0.40; 95% 0.38,0.42) than patients with HF-REF. The present results from a large, population-based sample suggest considerable variation in the prior and new use of different cardiac medication classes of drugs in patients with HF-PEF vs. HF-REF.