Despite the fact that ischemic CAD is the most common cause of HF, most patients with HF are not tested for it, researchers reported in the Journal of the American College of Cardiology.
“This is relevant, not only because ischemic CAD represents a potentially treatable (or reversible) cause of HF, but also because the presence of CAD can be synergistically and independently associated with worsened long-term outcomes," Darshan Doshi, MD, MS, of the division of cardiology at the Columbia University Medical Center/New York-Presbyterian Hospital and colleagues wrote.
Doshi and colleagues used data from the Truven Health MarketScan Commercial and Medicare Supplemental databases between 2011 and 2013 to investigate the patterns of ischemic testing and revascularization for patients hospitalized with new-onset HF.
Of the 79,057 patients with a diagnosis of new-onset HF analyzed (67,161 with 90-day follow-up), 42,479 had a diagnosis of CAD at baseline. During the index hospitalization and 90-day follow-up, only a small number of patients were tested for ischemic CAD (17.5% at index hospitalization; 27.4% at 90 days).
Odds of testing
Patients with no history of CAD at baseline were less likely to be tested than those without CAD at baseline both during the hospitalization (16.5% vs. 18.3%; P < .001) and within 90 days after (26.9% vs. 27.8%; P = .009), according to the researchers.
Fewer than one in 10 patients received noninvasive ischemic testing for CAD during the index hospitalization, a figure which rose to 14.6% at 90 days, according to the findings. Those diagnosed with CAD at baseline were more likely to have noninvasive testing for CAD at hospitalization than those without the diagnosis (OR = 1.25; 95% CI, 1.17-1.33).
Invasive testing was more likely given when the patients had baseline CAD (OR = 1.93; 95% CI, 1.83-2.05; P < .0001) or if they were smokers or had HF with reduced ejection fraction. Revascularization was performed in 2.1% of the patients during index hospitalization and 4.3% within 90 days.
“These data suggested significant underutilization of guideline-recommended assessments for ischemic CAD in new-onset HF patients,” Doshi and colleagues wrote.
More aggressive testing
James B. Young
In a related editorial, James B. Young, MD, from Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine and the Heart and Vascular Institute at Cleveland Clinic and Cardiology Today section editor, and Josef Stehlik, MD, MPH, of the division of cardiovascular medicine at the University of Utah School of Medicine and the Thoracic Transplant Registry of the International Society for Heart and Lung Transplantation, wrote that more patients in this population should be tested for ischemic CAD.
“If data indicate, which they do, that select diagnostic and therapeutic procedures are beneficial in appropriate patients, and if guidelines address this situation in reasonable fashion, which they do, it makes sense that more aggressive testing for [ischemic heart disease] (and determining any relationship to new-onset [HF]) should occur. Subsequently, delivery of guideline-recommended interventional revascularization procedures should then follow,” they wrote. – by Tracey Romero
Disclosure: The study was sponsored by Abiomed. Doshi reports receiving an educational grant from Abiomed. Please see the full study for a list of all other researchers’ relevant financial disclosures. Stehlik and Young report no relevant financial disclosures.