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In new-onset HF, rate of CAD testing lower than expected

Adam D. DeVore

Fewer than half of patients with new-onset HF are tested for CAD, and even fewer are tested during their index hospitalization.

Additionally, likelihood for CAD testing varied by patient age, sex and left ventricular ejection fraction, according to research presented at the American College of Cardiology Scientific Session and simultaneously published in Circulation: Heart Failure.

According to an analysis of data from the Get With the Guidelines-Heart Failure registry linked to Medicare claims, researchers observed that only 39% of patients with new-onset HF received testing for CAD, with just 23% receiving testing during index hospitalization.

Moreover, patients who received testing for CAD were younger (OR per year increase in age = 0.92; 95% CI, 0.91-0.93), more likely to be a man (OR for women vs. men = 0.91; 95% CI, 0.84-0.97) and more likely to have HF with reduced ejection fraction (OR for HFrEF vs. HF with preserved ejection fraction = 2.42; 95% CI, 2.21-2.65).

Odds for CAD testing also increased with time in patients with HFrEF, rising from 50% in 2009 to 61% in 2015 (P < .0001), and in patients with HF with borderline ejection fraction (HFbEF), rising from 38% in 2009 to 46% in 2015 (P = .01).

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In the U.S., less than half of new-onset HF patients receive CAD testing and even fewer receive it at their index hospitalization.

“The observed low rates of testing for CAD are surprising, given that many hospitals in the U.S. have the ability to evaluate for CAD [through] multiple noninvasive as well as invasive diagnostic modalities,” Adam D. DeVore, MD, assistant professor of medicine at Duke University School of Medicine and member of the Duke Clinical Research Institute, and colleagues wrote in Circulation: Heart Failure. “The reasons for low rates of testing for CAD in patients hospitalized with new-onset HF, despite guideline recommendations, are unknown and not apparent from our data.”

After excluding the patients with prior CAD, researchers found similar rates for testing for CAD (37%) and determined that testing again differed by LVEF category (54% in HFrEF; 42% in HFbEF; 28% in HFpEF; standardized difference, 51.5%).

“Testing for coronary artery disease is more common in patients with traditional clinical risk factors for coronary artery disease (eg, hyperlipidemia) but was also more common in patients receiving other recommended care (eg, anticoagulation for atrial fibrillation),” DeVore told Healio. “The current study highlights an opportunity to test the impact of prospective interventions designed to improve the rates of testing for coronary artery disease in patients with heart failure and assess the potential impact on outcomes.”

For this study (mean age, 81 years; 57% women; 84% white), researchers collected LVEF, prior HF history and in-hospital CAD testing from the Get With the Guidelines-Heart Failure registry and testing for CAD using claims data from 90 days before and after index HF hospitalization.

“Improving outcomes for patients with heart failure is an important public health goal. It is a common disorder that affects more than 6 million adults and decompensations are a common cause for hospitalizations in the U.S. — an important driver of U.S. health care costs,” DeVore said in an interview. “This study highlights a potential avenue to improve treatment for these patients using already-existing testing and well-studied medicines for coronary artery disease.” – by Scott Buzby

References:

O’Connor KD, et al. Abstract 1260-096. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).

O’Connor KD, et al. Circ Heart Fail. 2020;doi:10.1161/CIRCHEARTFAILURE.119.006963.

Disclosures: DeVore reports he received research funding from the American Heart Association, Amgen, AstraZeneca, Bayer, Intra-Cellular Therapies, Luitpold Pharmaceuticals, Merck, NHLBI, Novartis and Patient-Centered Outcomes Research Institute (PCORI), and is a consultant for Amgen, AstraZeneca, Bayer, InnaMed, LivaNova, Mardil Medical, Novartis, Procyrion, scPharmaceuticals and Zoll. Please see the study for all other authors’ relevant financial disclosures.

Adam D. DeVore

Fewer than half of patients with new-onset HF are tested for CAD, and even fewer are tested during their index hospitalization.

Additionally, likelihood for CAD testing varied by patient age, sex and left ventricular ejection fraction, according to research presented at the American College of Cardiology Scientific Session and simultaneously published in Circulation: Heart Failure.

According to an analysis of data from the Get With the Guidelines-Heart Failure registry linked to Medicare claims, researchers observed that only 39% of patients with new-onset HF received testing for CAD, with just 23% receiving testing during index hospitalization.

Moreover, patients who received testing for CAD were younger (OR per year increase in age = 0.92; 95% CI, 0.91-0.93), more likely to be a man (OR for women vs. men = 0.91; 95% CI, 0.84-0.97) and more likely to have HF with reduced ejection fraction (OR for HFrEF vs. HF with preserved ejection fraction = 2.42; 95% CI, 2.21-2.65).

Odds for CAD testing also increased with time in patients with HFrEF, rising from 50% in 2009 to 61% in 2015 (P < .0001), and in patients with HF with borderline ejection fraction (HFbEF), rising from 38% in 2009 to 46% in 2015 (P = .01).

#
In the U.S., less than half of new-onset HF patients receive CAD testing and even fewer receive it at their index hospitalization.

“The observed low rates of testing for CAD are surprising, given that many hospitals in the U.S. have the ability to evaluate for CAD [through] multiple noninvasive as well as invasive diagnostic modalities,” Adam D. DeVore, MD, assistant professor of medicine at Duke University School of Medicine and member of the Duke Clinical Research Institute, and colleagues wrote in Circulation: Heart Failure. “The reasons for low rates of testing for CAD in patients hospitalized with new-onset HF, despite guideline recommendations, are unknown and not apparent from our data.”

After excluding the patients with prior CAD, researchers found similar rates for testing for CAD (37%) and determined that testing again differed by LVEF category (54% in HFrEF; 42% in HFbEF; 28% in HFpEF; standardized difference, 51.5%).

“Testing for coronary artery disease is more common in patients with traditional clinical risk factors for coronary artery disease (eg, hyperlipidemia) but was also more common in patients receiving other recommended care (eg, anticoagulation for atrial fibrillation),” DeVore told Healio. “The current study highlights an opportunity to test the impact of prospective interventions designed to improve the rates of testing for coronary artery disease in patients with heart failure and assess the potential impact on outcomes.”

For this study (mean age, 81 years; 57% women; 84% white), researchers collected LVEF, prior HF history and in-hospital CAD testing from the Get With the Guidelines-Heart Failure registry and testing for CAD using claims data from 90 days before and after index HF hospitalization.

“Improving outcomes for patients with heart failure is an important public health goal. It is a common disorder that affects more than 6 million adults and decompensations are a common cause for hospitalizations in the U.S. — an important driver of U.S. health care costs,” DeVore said in an interview. “This study highlights a potential avenue to improve treatment for these patients using already-existing testing and well-studied medicines for coronary artery disease.” – by Scott Buzby

References:

O’Connor KD, et al. Abstract 1260-096. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).

O’Connor KD, et al. Circ Heart Fail. 2020;doi:10.1161/CIRCHEARTFAILURE.119.006963.

Disclosures: DeVore reports he received research funding from the American Heart Association, Amgen, AstraZeneca, Bayer, Intra-Cellular Therapies, Luitpold Pharmaceuticals, Merck, NHLBI, Novartis and Patient-Centered Outcomes Research Institute (PCORI), and is a consultant for Amgen, AstraZeneca, Bayer, InnaMed, LivaNova, Mardil Medical, Novartis, Procyrion, scPharmaceuticals and Zoll. Please see the study for all other authors’ relevant financial disclosures.

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