December 12, 2017

Nurse Researcher Studies Link Between Pharmacotherapy Choices and Mortality in Heart Failure Patients

Early treatment targeting three neurohormonal systems may be better than two

17-NUR-4329-Albert-Hero-Image-650x450pxl

In October, Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FAAN, wrapped up a year-long collaborative research project on the association between initial pharmacotherapy (IPT) and two-year mortality for patients with heart failure and reduced ejection fraction (HFrEF). Dr. Albert, who serves as ACNO of Cleveland Clinic’s Office of Nursing Research and Innovation, teamed up with six other researchers from Comprehensive Health Insights in Louisville, Kentucky, and Novartis Pharmaceuticals Corp. in East Hanover, New Jersey, on the study.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“Using a retrospective, single cohort design, we examined the association between real-world initial heart failure pharmacotherapy and two-year all-cause mortality in a Medicare managed care cohort of patients with HFrEF,” says Dr. Albert. “Our research methodology allowed us to better understand initial HFrEF pharmacotherapy, defined as prescribed in the first month. The sample was large and diverse, minimizing provider and health system biases.”

Background and methods

Heart failure is a debilitating condition that currently affects approximately 6.5 million adults in the United States, according to a 2017 update from the American Heart Association. Initiation of appropriate medication treatment following HFrEF diagnosis is recommended to optimize clinical outcomes. National guidelines promote HFrEF initial therapy with a renin-angiotensin antagonist and beta-blocker, as well as added aldosterone antagonist or hydralazine/nitrate prescriptions when patients remain symptomatic.

However, there are numerous reports in the literature that highlight healthcare provider prescription nonadherence to evidence-based heart failure pharmacological therapies known to improve survival. Therefore, Dr. Albert and her peers studied the association between initial HFrEF pharmacologic therapies and two-year mortality for patients with HFrEF.

The study utilized claims data from Humana Inc., a large national health insurance provider whose patient population is distributed primarily in the Southern and Midwestern U.S. The research team examined the claims database of 14,359 Medicare patients with HFrEF from August 2010 to July 2015. Patients were included in the study if they had at least two medical claims for heart failure, were between 19 and 89 years old and were continuously enrolled in the health plan for at least one year pre-index date (the date of the first observed heart failure diagnosis) and two years post-index, or until death.

Advertisement

Initial pharmacotherapy was based on the prevailing 2013 American College of Cardiology Foundation/American Heart Association guidelines for managing HFrEF during the enrollment period. Heart failure medications included any mono, dual, triple or higher combination therapy.

Study results and implications for practice

One of the main findings of the study was that 32.4 percent of the 14,359 Medicare managed care beneficiaries with HFrEF did not have heart failure pharmacotherapy initiated within one year of diagnosis. In addition, the use of three medication classes as initial pharmacologic therapy – renin-angiotensin antagonist, beta-blocker and aldosterone antagonist or hydralazine/nitrate – were associated with the lowest all-cause two-year hazard ratio of mortality after controlling for nonpharmacologic factors associated with mortality.

“Healthcare providers need to be more vigilant in prescribing HfrEF pharmacological therapies,” says Dr. Albert. “More research and practice changes are needed to determine rationale for lack of initial therapy and, also, processes and systems to optimize HFrEF pharmacological therapies when gaps in care exist.” She adds that more research is needed to learn if triple therapy should be initiated very early (within one month of initial HFrEF pharmacological therapies), as it was a three-drug class regimen that was associated with the lowest two-year mortality.

New research in real-world patients who are taking HFrEF pharmacologic therapies is ongoing. Results of the initial retrospective study were published in the October 2017 issue of Advances in Therapy.

Advertisement

Cleveland Clinic’s 14th annual Nursing Research Conference is May 2 – May 3. Register now!

Related Articles

heart showing obstructive cardiomyopathy
March 29, 2024
Mavacamten in the Real World: Study Demonstrates Safe Reduction in Eligibility for Septal Reduction Therapy

Logistic feasibility supported for treating obstructive HCM under the REMS program

mesh stent in a carotid artery
March 28, 2024
Carotid Revascularization Following the New CMS Coverage Decision: How to Operationalize Policies to Prioritize Outcomes

Insights from the Cleveland Clinic experience and a multispecialty alliance

tumor in an upper chamber of the heart
March 21, 2024
Excellent Outcomes Achievable With Surgical Resection of Benign Cardiac Tumors

Recurrences were rare and survival robust in large Cleveland Clinic study

illustration of the human heart focused on the left atrial appendage
March 12, 2024
Takeaways From Updated STS Guidelines for Surgical Treatment of Atrial Fibrillation

Concomitant AF ablation and LAA occlusion strongly endorsed during elective heart surgery

illustration of a figure-of-8 stitch for aortic valve repair
March 7, 2024
Figure-of-8, Hitch-Up Stitch Is Safe and Durable in Bicuspid Aortic Valve Repair

Large retrospective study supports its addition to BAV repair toolbox at expert centers

histology image of lung tissue showing spread through air spaces (STAS)
March 5, 2024
Lung Cancer Study Links Preoperative Factors With Spread Through Air Spaces

Young age, solid tumor, high uptake on PET and KRAS mutation signal risk, suggest need for lobectomy

x-ray of bone fracture in a forearm
March 1, 2024
TRAVERSE Substudy Links Testosterone Therapy to Increased Fracture Risk in Older Men With Hypogonadism

Surprise findings argue for caution about testosterone use in men at risk for fracture

echocardiogram showing severe aortic regurgitation
February 28, 2024
Early Referral for Enlarged Roots Critical to Prevent Residual AR After Aortic Root Replacement With Valve Reimplantation

Residual AR related to severe preoperative AR increases risk of progression, need for reoperation

Ad