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Published on: December 11, 2017
Predictors of clinical outcomes in patients given carvedilol for heart failure
Barry Greenberg1, Sandra R Lottes, Jeanenne J Nelson
1University of California, San Diego, School of Medicine, San Diego, California, USA.
Insights
Easily obtained patient history, including heart failure (HF) severity and prior hospitalizations, predicts adverse outcomes after carvedilol treatment. These factors are more reliable than left ventricular ejection fraction for risk assessment in community HF populations.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Traditional heart failure (HF) risk factor assessment often relies on data from clinical trials or specific patient subgroups.
- Previous risk factor models predate the widespread use of beta-blocker therapies like carvedilol.
- Community-based registries offer valuable insights into real-world HF management and outcomes.
Purpose of the Study:
- To identify independent risk factors for adverse outcomes in a community-based heart failure (HF) population one year after initiating carvedilol.
- To compare the predictive value of historical patient data versus left ventricular ejection fraction (LVEF) for HF outcomes.
- To evaluate the impact of HF etiology and physician experience on patient outcomes.
Main Methods:
- Observation of 4,280 patients in a community HF registry for one year post-carvedilol titration.
- Identification of risk factors through age-, gender-, and race-adjusted analyses, followed by multivariate analysis.
- Assessment of outcomes including all-cause mortality, HF hospitalization, and other cardiovascular hospitalizations.
Main Results:
- Significant predictors of adverse outcomes included New York Heart Association (NYHA) class III/IV, prior HF or cardiovascular hospitalizations, and angina pectoris.
- Left ventricular ejection fraction (LVEF) was not a significant predictor in multivariate analysis.
- Reduced adverse event odds were observed for patients with hypertensive/idiopathic HF and those treated by physicians with over 24 years of experience.
Conclusions:
- Simple historical data, such as NYHA class and hospitalization history, effectively predict clinical outcomes in community HF patients on carvedilol.
- These historical factors demonstrated superior predictive power compared to LVEF in this unselected population.
- Findings support the use of readily available historical information for risk stratification in heart failure management.
Abstract:
Risk factors for outcomes in heart failure (HF) were derived from populations in clinical trials, at hospital discharge, or in localized geographic or socioeconomic strata before the widespread use of beta blockers. This study observed 4,280 patients in a community-based HF registry for 1 year after completing carvedilol titration. Independent risk factors for death, hospitalization for HF, or hospitalization for cardiovascular reasons other than HF were first identified by age-, gender-, and race-adjusted analyses, then by multivariate analysis adjusted simultaneously for all factors. Over this period, 7% of patients died, 11% were hospitalized for HF, 12% were hospitalized for other cardiovascular reasons, and 27% had > or =1 of these events. The most significant outcome predictors were New York Heart Association class III or IV, history of hospitalization for HF or other cardiovascular reasons, and angina pectoris, all associated with increased odds of having an adverse outcome (all p < or =0.001). The left ventricular ejection fraction was not a significant outcome predictor by multivariate analysis. The odds ratio for an adverse outcome was significantly reduced for patients with hypertensive or idiopathic causes of HF and for those whose physicians had graduated from medical school > or =24 years earlier compared with <14 years earlier (all p <0.005). In conclusion, easily obtained historical information predicts clinical outcomes in patients with HF in the year after initiating carvedilol. In this unselected community population, these historical factors were better predictors of risk than the left ventricular ejection fraction.
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