Phillip Lam

Lack of evidence of lower 30-day all-cause readmission in Medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone ☆

BACKGROUND Therapy with evidence-based heart failure (HF) medications has been shown to be associated with lower risk of 30-day all-cause readmission in patients with HF and reduced ejection fraction (HFrEF). METHODS We examined the association of aldosterone antagonist use with 30-day all-cause readmission in this population. Of the 2443 Medicare beneficiaries with HF and left ventricular EF ≤35% discharged home from 106 Alabama hospitals during 1998-2001, 2060 were eligible for spironolactone therapy (serum creatinine ≤2.5 for men and ≤2mg/dl for women, and serum potassium <5mEq/L). After excluding 186 patients already receiving spironolactone on admission, the inception cohort consisted of 1874 patients eligible for a new discharge prescription for spironolactone, of which 329 received one. Using propensity scores for initiation of spironolactone therapy, we assembled a matched cohort of 324 pairs of patients receiving and not receiving spironolactone balanced on 34 baseline characteristics (mean age 72years, 42% women, 33% African American). RESULTS Thirty-day all-cause readmission occurred in 17% and 19% of matched patients receiving and not receiving spironolactone, respectively (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.64-1.32; p=0.650). Spironolactone had no association with 30-day all-cause mortality (HR, 0.84; 95% CI, 0.38-1.88; p=0.678) or HF readmission (HR, 0.74; 95% CI, 0.41 1.31; p=0.301). These associations remained unchanged during 12months of post-discharge follow-up. CONCLUSION A discharge prescription for spironolactone had no association with 30-day all-cause readmission among older, hospitalized Medicare beneficiaries with HFrEF eligible for spironolactone therapy.

Similar Clinical Benefits from Below-Target and Target Dose Enalapril in Patients with Heart Failure in the SOLVD Treatment Trial.

To examine associations of below‐target and target dose of enalapril, an angiotensin‐converting enzyme (ACE) inhibitor, with outcomes in patients with heart failure and reduced ejection fraction (HFrEF) in the Studies of Left Ventricular Dysfunction (SOLVD) Treatment trial.

Systolic–diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study

BACKGROUND Isolated systolic hypertension (ISH) is common in older adults and is a risk factor for incident heart failure (HF). We examined the association of systolic-diastolic hypertension (SDH) with incident HF and other outcomes in older adults. METHODS In the Cardiovascular Health Study (CHS), 5776 community-dwelling adults≥65years had data on baseline systolic and diastolic blood pressure (SBP and DBP). We excluded those with DBP<60mmHg (n=821), DBP≥90 and SBP<140mmHg (n=28), normal BP, taking anti-hypertensive drugs (n=1138), normal BP, not taking anti-hypertensive drugs, history of hypertension (n=193), and baseline HF (n=101). Of the remaining 3495, 1838 had ISH (SBP≥140 and DBP<90mmHg) and 240 had SDH (SBP≥140 and DBP≥90mmHg). The main outcome was centrally-adjudicated incident HF over 13years of follow-up. RESULTS Participants had a mean (±SD) age of 73 (±6)years, 57% were women, and 16% African American. Incident HF occurred in 25%, 22% and 11% of participants with ISH, SDH and no hypertension, respectively. Compared to no hypertension, multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident HF associated with ISH and SDH were 1.86 (1.51-2.30) and 1.73 (1.23-2.42), respectively. Cardiovascular mortality occurred in 22%, 24% and 9% of those with ISH, SDH and no hypertension, respectively with respective multivariable-adjusted HRs (95% CIs) of 1.88 (1.49-2.37) and 2.30 (1.64-3.24). CONCLUSION Among older adults with hypertension, both SDH and ISH have similar associations with incident HF and cardiovascular mortality.

ACUTE MANAGEMENT OF INTERVENTRICULAR SEPTAL HEMATOMA AFTER AN ST-ELEVATION MYOCARDIAL INFARCTION IN THE SETTING OF RECENT SUBDURAL HEMATOMA

Interventricular septal hematoma is a rare occurrence involving dissection of the myocardium. It can result from myocardial infarction, trauma, surgery, or percutaneous coronary intervention (PCI). Management is not well defined. A 72 year old male presented with chest pain. His medical history was

INITIATION OF LOOP DIURETIC THERAPY IS ASSOCIATED WITH A LOWER RISK OF 30-DAY ALL-CAUSE READMISSION IN PATIENTS WITH HEART FAILURE NOT RECEIVING DIURETICS PRIOR TO HOSPITALIZATION

Heart failure (HF) is the leading cause of 30-day all-cause readmission. Diuretics are often used to achieve and maintain euvolemia. However, they may cause neurohormonal activation and electrolyte imbalance and their use may increase the risk of long-term poor outcomes. We examined the association

PREDICTORS OF 6-MONTH HEART FAILURE READMISSION AND DEATH IN OLDER PATIENTS WITH HEART FAILURE WITH PRESERVED VERSUS REDUCED EJECTION FRACTION

Determining a 6mo life expectancy for hospice referral may be challenging in heart failure (HF) patients, especially in HFpEF. We conducted 2 case-control studies to identify admission clinical features associated with 6-month poor outcomes in HFpEF and HFrEF. In Medicare-linked OPTIMIZE-HF, 8873

SMOKING AND OUTCOMES IN OLDER PATIENTS WITH HEART FAILURE AND PRESERVED EJECTION FRACTION (HFPEF)

Cigarette smoking is a risk factor for heart failure (HF; PMC5499230), but in patients hospitalized for HF smoking has a paradoxical short-term beneficial association (PMID: 18487210). We examined the association of smoking with long-term outcomes in HFpEF. Of the 8873 patients hospitalized for HF

ASSOCIATIONS OF SYSTOLIC BLOOD PRESSURE (SBP) <120 (VERSUS 120-139) MMHG WITH OUTCOMES IN PATIENTS WITH HEART FAILURE AND PRESERVED EJECTION FRACTION (HFPEF) WITHOUT HYPERTENSION (HTN)

According to the 2017 update of 2013 ACCF/AHA HF guideline, SBP should be lowered to <130 mmHg in patients with HFpEF and HTN. However, less is known about the association of lower SBP and outcomes in HFpEF without HTN. Of the 8873 hospitalized patients with HF and EF ≥50% in Medicare-linked

Digoxin use and lower risk of 30-day all-cause readmission in older patients with heart failure and reduced ejection fraction receiving β-blockers.

Digoxin use has been associated with a lower risk of 30‐day all‐cause admission and readmission in patients with heart failure and reduced ejection fraction (HFrEF).

HEART FAILURE HOSPITALIZATION (HFH) DESPITE DIGOXIN THERAPY VERSUS NO HFH DESPITE PLACEBO IN THE DIGITALIS INVESTIGATION GROUP (DIG) TRIAL: INSIGHTS INTO RISK FACTORS FOR HFH IN HF AND REDUCED EJECTION FRACTION (HFREF)

Background: In the DIG trial, 6800 patients with HFrEF (EF≤45%) were randomized to receive either placebo (n=3403) or digoxin (n=3397) and followed for a mean of 37 months. Digoxin significantly reduced the risk of HFH by 28% (HR, 0.72; 95% CI, 0.66–0.79). However, 27% of patients in the digoxin