Pulmonary Vascular Load Impairs Dynamic Right Ventricular-pulmonary Artery Coupling And Increases Lung Congestion During Exercise In Left Heart Disease
HFSA ePoster Library. Omote K. 09/10/21; 343456; 223
Kazunori Omote
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Abstract
Discussion Forum (0)
Introduction: Randomized clinical trials (RCT) in populations having heart failure with reduced ejection fraction (HFrEF) include stringent selection criteria and may not be reflective of the general HF population. We assessed the representativeness of the GALACTIC-HF RCT in a real-world HFrEF population.
Methods: We included Kaiser Permanente Southern California patients with a HF diagnosis and ejection fraction (EF) ≤ 40% from 2014-2018 using electronic health records. Four mutually exclusive cohorts were created. These include real-world cohorts: 1) not taking guideline-directed medical therapy (GDMT), 2) taking GDMT and RCT-like cohorts with: 3) EF ≤ 35% and 4) EF 36-40%. Hazard ratios (HR) and 95% confidence intervals (CI) for 30-day and 1-year all-cause mortality and, separately, hospitalization were calculated comparing cohorts.
Results: Among 12,772 HFrEF patients, 3,626 (28%) met strict GALACTIC-HF criteria with EF ≤ 35% and 884 (7%) met all GALACTIC-HF criteria except for EF, with an EF of 36-40%. Age (mean 71 years), sex (67% male), racial/ethnic distribution (48% non-Hispanic white, 18% black, 25% Hispanic), and baseline measures including heart rate were comparable between all cohorts. (Table) Overall, 30-day mortality and hospitalization were lower among all cohorts vs. the real-world cohort not taking GDMT. (Table) Similarly, the risk of 1-year mortality was lower among all cohorts vs. the real-world cohort not taking GDMT. The risk of 1-year hospitalization was only lower among the real-world cohort taking GDMT vs. the real-world cohort not taking GDMT
Conclusion: Only 28% of HFrEF patients met complete GALACTIC-HF criteria. RCT-like cohorts had lower mortality, but similar 1-year hospitalization rates compared to real-world HFrEF patients not taking GDMT, suggesting the potential for additional treatment benefits.
Methods: We included Kaiser Permanente Southern California patients with a HF diagnosis and ejection fraction (EF) ≤ 40% from 2014-2018 using electronic health records. Four mutually exclusive cohorts were created. These include real-world cohorts: 1) not taking guideline-directed medical therapy (GDMT), 2) taking GDMT and RCT-like cohorts with: 3) EF ≤ 35% and 4) EF 36-40%. Hazard ratios (HR) and 95% confidence intervals (CI) for 30-day and 1-year all-cause mortality and, separately, hospitalization were calculated comparing cohorts.
Results: Among 12,772 HFrEF patients, 3,626 (28%) met strict GALACTIC-HF criteria with EF ≤ 35% and 884 (7%) met all GALACTIC-HF criteria except for EF, with an EF of 36-40%. Age (mean 71 years), sex (67% male), racial/ethnic distribution (48% non-Hispanic white, 18% black, 25% Hispanic), and baseline measures including heart rate were comparable between all cohorts. (Table) Overall, 30-day mortality and hospitalization were lower among all cohorts vs. the real-world cohort not taking GDMT. (Table) Similarly, the risk of 1-year mortality was lower among all cohorts vs. the real-world cohort not taking GDMT. The risk of 1-year hospitalization was only lower among the real-world cohort taking GDMT vs. the real-world cohort not taking GDMT
Conclusion: Only 28% of HFrEF patients met complete GALACTIC-HF criteria. RCT-like cohorts had lower mortality, but similar 1-year hospitalization rates compared to real-world HFrEF patients not taking GDMT, suggesting the potential for additional treatment benefits.
Introduction: Randomized clinical trials (RCT) in populations having heart failure with reduced ejection fraction (HFrEF) include stringent selection criteria and may not be reflective of the general HF population. We assessed the representativeness of the GALACTIC-HF RCT in a real-world HFrEF population.
Methods: We included Kaiser Permanente Southern California patients with a HF diagnosis and ejection fraction (EF) ≤ 40% from 2014-2018 using electronic health records. Four mutually exclusive cohorts were created. These include real-world cohorts: 1) not taking guideline-directed medical therapy (GDMT), 2) taking GDMT and RCT-like cohorts with: 3) EF ≤ 35% and 4) EF 36-40%. Hazard ratios (HR) and 95% confidence intervals (CI) for 30-day and 1-year all-cause mortality and, separately, hospitalization were calculated comparing cohorts.
Results: Among 12,772 HFrEF patients, 3,626 (28%) met strict GALACTIC-HF criteria with EF ≤ 35% and 884 (7%) met all GALACTIC-HF criteria except for EF, with an EF of 36-40%. Age (mean 71 years), sex (67% male), racial/ethnic distribution (48% non-Hispanic white, 18% black, 25% Hispanic), and baseline measures including heart rate were comparable between all cohorts. (Table) Overall, 30-day mortality and hospitalization were lower among all cohorts vs. the real-world cohort not taking GDMT. (Table) Similarly, the risk of 1-year mortality was lower among all cohorts vs. the real-world cohort not taking GDMT. The risk of 1-year hospitalization was only lower among the real-world cohort taking GDMT vs. the real-world cohort not taking GDMT
Conclusion: Only 28% of HFrEF patients met complete GALACTIC-HF criteria. RCT-like cohorts had lower mortality, but similar 1-year hospitalization rates compared to real-world HFrEF patients not taking GDMT, suggesting the potential for additional treatment benefits.
Methods: We included Kaiser Permanente Southern California patients with a HF diagnosis and ejection fraction (EF) ≤ 40% from 2014-2018 using electronic health records. Four mutually exclusive cohorts were created. These include real-world cohorts: 1) not taking guideline-directed medical therapy (GDMT), 2) taking GDMT and RCT-like cohorts with: 3) EF ≤ 35% and 4) EF 36-40%. Hazard ratios (HR) and 95% confidence intervals (CI) for 30-day and 1-year all-cause mortality and, separately, hospitalization were calculated comparing cohorts.
Results: Among 12,772 HFrEF patients, 3,626 (28%) met strict GALACTIC-HF criteria with EF ≤ 35% and 884 (7%) met all GALACTIC-HF criteria except for EF, with an EF of 36-40%. Age (mean 71 years), sex (67% male), racial/ethnic distribution (48% non-Hispanic white, 18% black, 25% Hispanic), and baseline measures including heart rate were comparable between all cohorts. (Table) Overall, 30-day mortality and hospitalization were lower among all cohorts vs. the real-world cohort not taking GDMT. (Table) Similarly, the risk of 1-year mortality was lower among all cohorts vs. the real-world cohort not taking GDMT. The risk of 1-year hospitalization was only lower among the real-world cohort taking GDMT vs. the real-world cohort not taking GDMT
Conclusion: Only 28% of HFrEF patients met complete GALACTIC-HF criteria. RCT-like cohorts had lower mortality, but similar 1-year hospitalization rates compared to real-world HFrEF patients not taking GDMT, suggesting the potential for additional treatment benefits.
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