Clinical InvestigationCongestive Heart FailureCharacteristics and in-hospital outcomes for nonadherent patients with heart failure: Findings from Get With The Guidelines-Heart Failure (GWTG-HF)
Section snippets
Methods
The GWTG-HF program is overseen by the American Heart Association and is an ongoing, prospective observational data collection and quality improvement initiative.7 Hospitals participating in this registry include institutions from all regions of the United States and represent community hospitals as well as tertiary referral centers. Trained individuals at each site submitted clinical information regarding medical history, hospital care, and outcomes for consecutive patients hospitalized for HF
Results
A total of 95,127 patients were identified among 333 hospitals from January 1, 2005 to December 30, 2007. Ninety-seven hospitals either did not provide information with regard to the precipitating cause of HF or had a high missing rate (>25%) on reporting patient medical history; thus, 32,495 patients were excluded. In addition, 8,310 patients were admitted with a first time diagnosis of HF and were also excluded. The final analysis cohort included 54,322 patients from 236 hospitals. Clinicians
Discussion
We investigated a broad cohort of US patients admitted with acute decompensated HF to evaluate the influence of nonadherence on quality of care and outcomes. This study has 3 main findings. First, nonadherence is a common precipitant for HF admission, and such patients are sociodemographically disadvantaged relative to patients without nonadherence. In addition, medication nonadherence was more commonly noted among younger patients, ethnic minorities, and the uninsured, whereas dietary
Conclusions
Among GWTG-HF hospitals, patients with nonadherence as a factor for HF hospitalization tended to be younger and more sociodemographically disadvantaged. Despite evidence of greater volume overload and lower EF, this population had better in-hospital outcomes. This lower risk-adjusted mortality and LOS suggests that it may be easier to stabilize nonadherent patients by reinstituting sodium and/or fluid restriction and resuming appropriate medical therapy. Patients with nonadherence were equally
Disclosures
Dr Fonarow reports receiving research grants and honoraria from GlaxoSmithKline and Medtronic and serves as a consultant for GlaxoSmithKline, Medtronic, and Novartis. He serves as chair of the American Heart Association’s Get With the Guidelines Steering Committee. He is supported by the Ahmanson and Elliot Corday Foundations. Dr Hernandez reports receiving research grants from Scios, Medtronic, GlaxoSmithKline, and Roche Diagnostics and has served on the speaker’s bureau or has received
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2021, American Journal of the Medical SciencesHeart failure etiologies and clinical factors precipitating for worsening heart failure: Findings from BIOSTAT-CHF
2020, European Journal of Internal Medicine
Dr. Hernandez received American Heart Association Pharmaceutical Roundtable grant 0675060N.
Jack V. Tu, MD, PhD served as guest editor on this manuscript.