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Published on: August 9, 2024
Association Between Coronary Artery Disease Testing in Patients with New-Onset Heart Failure and Heart Failure
Cheng-Wei Huang1,2, Siamak Kohan3, In-Lu Amy Liu4
1Department of Hospital Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA. Cheng-wei.huang@kp.org.
Insights
Coronary artery disease (CAD) testing in new-onset heart failure (HF) patients is linked to reduced hospital readmissions and mortality. Testing within 90 days, even after discharge, showed no worse outcomes, suggesting timely diagnosis benefits HF patients.
Area of Science:
- Cardiology
- Heart Failure Research
- Diagnostic Testing
Background:
- Coronary artery disease (CAD) testing is underutilized in new-onset heart failure (HF) patients.
- The impact of widespread CAD testing on outcomes in new-onset HF is not well-established.
Purpose of the Study:
- To investigate the association between CAD testing, and its timing, and outcomes in hospitalized patients with new-onset heart failure with reduced ejection fraction (HFrEF).
Main Methods:
- Retrospective cohort study of 2729 adult patients hospitalized with new-onset HFrEF between 2016-2021.
- Primary outcome: composite of HF readmission or all-cause mortality.
- CAD testing timing analyzed as early (pre-discharge) vs. late (up to 90 days post-discharge).
Main Results:
- 54.5% of patients received CAD testing.
- CAD testing was associated with a reduced risk of HF readmission or all-cause mortality (aHR 0.71 [0.63-0.79]).
- No significant difference in outcomes between early and late testing (aHR 0.97 [0.81-1.16]).
Conclusions:
- CAD testing within 90 days of hospitalization is associated with improved outcomes in new-onset HFrEF.
- Testing up to 90 days post-discharge is not associated with adverse outcomes, supporting timely diagnostic evaluation.
Background:
In patients with new-onset heart failure (HF), coronary artery disease (CAD) testing remains underutilized. Whether widespread CAD testing in patients with new-onset HF leads to improved outcomes remains to be determined.
Objective:
We sought to examine whether CAD testing, and its timing, among patients hospitalized with new-onset HF with reduced ejection fraction (HFrEF), is associated with improved outcomes.
Design:
Retrospective cohort study.
Participants:
Adult (≥ 18 years) non-pregnant patients with new-onset HFrEF hospitalized within one of 15 Kaiser Permanente Southern California medical centers between 2016 and 2021. Key exclusion criteria included history of heart transplant, hospice, and a do-not-resuscitate order.
Main Measures:
Primary outcome was a composite of HF readmission or all-cause mortality through end of follow-up on 12/31/2022.
Key Results:
Among 2729 patients hospitalized with new-onset HFrEF, 1487 (54.5%) received CAD testing. The median age was 66 (56-76) years old, 1722 (63.1%) were male, and 1074 (39.4%) were White. After a median of 1.8 (0.6-3.4) years, the testing group had a reduced risk of HF readmission or all-cause mortality (aHR [95%CI], 0.71 [0.63-0.79]). These results were consistent across subgroups by history of atrial fibrillation, diabetes, renal disease, myocardial infarction, and elevated troponin during hospitalization. In a secondary analysis where CAD testing was further divided to early (received testing before discharge) and late testing (up to 90 days after discharge), there was no difference in late vs early testing (0.97 [0.81-1.16]).
Conclusions:
In a contemporary and diverse cohort of patients hospitalized with new-onset HFrEF, CAD testing within 90 days of hospitalization was associated with a lower risk of HF readmission or all-cause mortality. Testing within 90 days after discharge was not associated with worse outcomes.
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