Inferior Vena Cava Diameter Independently Predicts Acute Decompensated Heart Failure Rehospitalizations
HFSA ePoster Library. Sampath-Kumar R. 09/10/21; 343537; 299
Revathy Sampath-Kumar
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Abstract
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Introduction Despite the strong evidence supporting guideline directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF), prescription rates in clinical practice are still lacking. The deficiency in medication optimization in patients with HFrEF may be a strong contributing factor to rehospitalizations. The objective of this survey was to assess the differences in priority when adjusting GDMT between cardiologists and internists.
Methods A survey containing 20 clinical vignettes of patients with heart failure with reduced ejection fraction (HFrEF) was answered by 127 cardiologists and 68 internal/family medicine physicians. Each vignette had 4-5 options for adjusting GDMT along with the option to make no changes. For analysis, responses were dichotomized to the answer of interest. A generalized linear mixed effect model was used to calculate odds ratios with provider type, confidence in making GDMT changes, number of patients with heart failure seen per week, and number of years treating patients with HF as fixed effects and the question and respondent as random effects.
Results Cardiologists were more likely to make changes to GDMT compared to internists (91.8% vs 82.0%; OR 1.84 [1.07-3.19]; p=0.020). Providers with higher confidence were also more likely to adjust GDMT compared to those with lower confidence (OR 1.20 [1.04-1.37]; p=0.007). In medically naïve patients, cardiologists were more likely to initiate beta-blockers compared to internists (46.3% vs 32.0%; OR 2.38 [1.18-4.81]; p = 0.016). Cardiologists were also more likely to initiate angiotensin receptor blockers/neprilysin inhibitors (ARNI) compared to internists (63.8% vs 48.1%; OR 1.76 [1.01-3.09]; p=0.047). Higher confidence and years of treating patients with HF also increased the odds of initiating ARNI (OR 1.37 [1.17-1.60], p=<0.001 and OR 1.03 [1.00-1.06]; p=0.039, respectively). Cardiologists were more likely to initiate hydralazine and isosorbide dinitrate compared to internists (38.2% vs 23.7%; OR 2.47 [1.48-4.12]; p<0.001). No differences were found in initiating ACEi/ARBs in patients on beta-blockers (35.5% vs 29.9%; OR 0.84 [0.5 -1.40]; p=0.505), initiating mineralocorticoid receptor antagonists (13.9% vs 11.5%; OR 1.25 [0.66-2.38]; p=0.495), sodium glucose cotransporter 2 inhibitors (13.3% vs 15.6%; OR 0.78 [0.44-1.38]; p=0.397), digoxin (20.7% vs 18.5%; OR 0.81 [0.36-1.80]; p=0.599), or ivabradine (24.6% vs 22.3% OR 0.78 [0.38-1.60]; p=0.499).
Conclusions Our results show that cardiologists were more likely to adjust GDMT compared to internists. Future focus on improving GDMT prescribing should target providers other than cardiologists to aid in improving care in patients with HFrEF.
Methods A survey containing 20 clinical vignettes of patients with heart failure with reduced ejection fraction (HFrEF) was answered by 127 cardiologists and 68 internal/family medicine physicians. Each vignette had 4-5 options for adjusting GDMT along with the option to make no changes. For analysis, responses were dichotomized to the answer of interest. A generalized linear mixed effect model was used to calculate odds ratios with provider type, confidence in making GDMT changes, number of patients with heart failure seen per week, and number of years treating patients with HF as fixed effects and the question and respondent as random effects.
Results Cardiologists were more likely to make changes to GDMT compared to internists (91.8% vs 82.0%; OR 1.84 [1.07-3.19]; p=0.020). Providers with higher confidence were also more likely to adjust GDMT compared to those with lower confidence (OR 1.20 [1.04-1.37]; p=0.007). In medically naïve patients, cardiologists were more likely to initiate beta-blockers compared to internists (46.3% vs 32.0%; OR 2.38 [1.18-4.81]; p = 0.016). Cardiologists were also more likely to initiate angiotensin receptor blockers/neprilysin inhibitors (ARNI) compared to internists (63.8% vs 48.1%; OR 1.76 [1.01-3.09]; p=0.047). Higher confidence and years of treating patients with HF also increased the odds of initiating ARNI (OR 1.37 [1.17-1.60], p=<0.001 and OR 1.03 [1.00-1.06]; p=0.039, respectively). Cardiologists were more likely to initiate hydralazine and isosorbide dinitrate compared to internists (38.2% vs 23.7%; OR 2.47 [1.48-4.12]; p<0.001). No differences were found in initiating ACEi/ARBs in patients on beta-blockers (35.5% vs 29.9%; OR 0.84 [0.5 -1.40]; p=0.505), initiating mineralocorticoid receptor antagonists (13.9% vs 11.5%; OR 1.25 [0.66-2.38]; p=0.495), sodium glucose cotransporter 2 inhibitors (13.3% vs 15.6%; OR 0.78 [0.44-1.38]; p=0.397), digoxin (20.7% vs 18.5%; OR 0.81 [0.36-1.80]; p=0.599), or ivabradine (24.6% vs 22.3% OR 0.78 [0.38-1.60]; p=0.499).
Conclusions Our results show that cardiologists were more likely to adjust GDMT compared to internists. Future focus on improving GDMT prescribing should target providers other than cardiologists to aid in improving care in patients with HFrEF.
Introduction Despite the strong evidence supporting guideline directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF), prescription rates in clinical practice are still lacking. The deficiency in medication optimization in patients with HFrEF may be a strong contributing factor to rehospitalizations. The objective of this survey was to assess the differences in priority when adjusting GDMT between cardiologists and internists.
Methods A survey containing 20 clinical vignettes of patients with heart failure with reduced ejection fraction (HFrEF) was answered by 127 cardiologists and 68 internal/family medicine physicians. Each vignette had 4-5 options for adjusting GDMT along with the option to make no changes. For analysis, responses were dichotomized to the answer of interest. A generalized linear mixed effect model was used to calculate odds ratios with provider type, confidence in making GDMT changes, number of patients with heart failure seen per week, and number of years treating patients with HF as fixed effects and the question and respondent as random effects.
Results Cardiologists were more likely to make changes to GDMT compared to internists (91.8% vs 82.0%; OR 1.84 [1.07-3.19]; p=0.020). Providers with higher confidence were also more likely to adjust GDMT compared to those with lower confidence (OR 1.20 [1.04-1.37]; p=0.007). In medically naïve patients, cardiologists were more likely to initiate beta-blockers compared to internists (46.3% vs 32.0%; OR 2.38 [1.18-4.81]; p = 0.016). Cardiologists were also more likely to initiate angiotensin receptor blockers/neprilysin inhibitors (ARNI) compared to internists (63.8% vs 48.1%; OR 1.76 [1.01-3.09]; p=0.047). Higher confidence and years of treating patients with HF also increased the odds of initiating ARNI (OR 1.37 [1.17-1.60], p=<0.001 and OR 1.03 [1.00-1.06]; p=0.039, respectively). Cardiologists were more likely to initiate hydralazine and isosorbide dinitrate compared to internists (38.2% vs 23.7%; OR 2.47 [1.48-4.12]; p<0.001). No differences were found in initiating ACEi/ARBs in patients on beta-blockers (35.5% vs 29.9%; OR 0.84 [0.5 -1.40]; p=0.505), initiating mineralocorticoid receptor antagonists (13.9% vs 11.5%; OR 1.25 [0.66-2.38]; p=0.495), sodium glucose cotransporter 2 inhibitors (13.3% vs 15.6%; OR 0.78 [0.44-1.38]; p=0.397), digoxin (20.7% vs 18.5%; OR 0.81 [0.36-1.80]; p=0.599), or ivabradine (24.6% vs 22.3% OR 0.78 [0.38-1.60]; p=0.499).
Conclusions Our results show that cardiologists were more likely to adjust GDMT compared to internists. Future focus on improving GDMT prescribing should target providers other than cardiologists to aid in improving care in patients with HFrEF.
Methods A survey containing 20 clinical vignettes of patients with heart failure with reduced ejection fraction (HFrEF) was answered by 127 cardiologists and 68 internal/family medicine physicians. Each vignette had 4-5 options for adjusting GDMT along with the option to make no changes. For analysis, responses were dichotomized to the answer of interest. A generalized linear mixed effect model was used to calculate odds ratios with provider type, confidence in making GDMT changes, number of patients with heart failure seen per week, and number of years treating patients with HF as fixed effects and the question and respondent as random effects.
Results Cardiologists were more likely to make changes to GDMT compared to internists (91.8% vs 82.0%; OR 1.84 [1.07-3.19]; p=0.020). Providers with higher confidence were also more likely to adjust GDMT compared to those with lower confidence (OR 1.20 [1.04-1.37]; p=0.007). In medically naïve patients, cardiologists were more likely to initiate beta-blockers compared to internists (46.3% vs 32.0%; OR 2.38 [1.18-4.81]; p = 0.016). Cardiologists were also more likely to initiate angiotensin receptor blockers/neprilysin inhibitors (ARNI) compared to internists (63.8% vs 48.1%; OR 1.76 [1.01-3.09]; p=0.047). Higher confidence and years of treating patients with HF also increased the odds of initiating ARNI (OR 1.37 [1.17-1.60], p=<0.001 and OR 1.03 [1.00-1.06]; p=0.039, respectively). Cardiologists were more likely to initiate hydralazine and isosorbide dinitrate compared to internists (38.2% vs 23.7%; OR 2.47 [1.48-4.12]; p<0.001). No differences were found in initiating ACEi/ARBs in patients on beta-blockers (35.5% vs 29.9%; OR 0.84 [0.5 -1.40]; p=0.505), initiating mineralocorticoid receptor antagonists (13.9% vs 11.5%; OR 1.25 [0.66-2.38]; p=0.495), sodium glucose cotransporter 2 inhibitors (13.3% vs 15.6%; OR 0.78 [0.44-1.38]; p=0.397), digoxin (20.7% vs 18.5%; OR 0.81 [0.36-1.80]; p=0.599), or ivabradine (24.6% vs 22.3% OR 0.78 [0.38-1.60]; p=0.499).
Conclusions Our results show that cardiologists were more likely to adjust GDMT compared to internists. Future focus on improving GDMT prescribing should target providers other than cardiologists to aid in improving care in patients with HFrEF.
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