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Association Between Coronary Assessment in Heart Failure and Clinical Outcomes Within a Safety-Net Setting Using a
Matthew S Durstenfeld1, Anjali Thakkar1, Yifei Ma1
1Division of Cardiology at Zuckerberg San Francisco General and Department of Medicine, University of California, San Francisco (UCSF).
Circulation. Cardiovascular Quality and Outcomes
|April 29, 2024
Summary
Early coronary assessment after heart failure diagnosis is linked to lower mortality. Disparities exist in who receives this assessment, with women and older individuals less likely to undergo it. Further research is needed to confirm findings.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Ischemic cardiomyopathy is the primary cause of heart failure (HF).
- Coronary assessment is infrequently performed after HF diagnosis, with no existing randomized trials.
- Disparities in coronary assessment exist within safety-net populations.
Purpose of the Study:
- To identify factors associated with coronary assessment post-HF diagnosis.
- To evaluate the association of early coronary assessment with mortality and other outcomes.
- To explore disparities in access to coronary assessment.
Main Methods:
- Utilized an electronic health record cohort (2001-2019) of individuals with HF.
- Employed target trial emulation and propensity scores for causal inference.
- Used national death records to ascertain mortality and included falsification endpoints.
Main Results:
- 26.9% of HF patients completed coronary assessment; women, older individuals, and those unstably housed were less likely to be assessed.
- Early coronary assessment was associated with lower all-cause mortality (HR 0.84) and a composite outcome (HR 0.86).
- Early assessment correlated with increased revascularization (OR 7.6) and medical therapy use (OR 2.5).
Conclusions:
- Disparities in coronary assessment after HF diagnosis persist and are not fully explained by traditional risk factors.
- Early coronary assessment may improve HF outcomes, potentially through increased revascularization and guideline-directed medical therapy.
- The certainty of these findings is limited by potential unmeasured confounding.
