[show abstract][hide abstract] ABSTRACT: Worsened renal function (WRF) during heart failure (HF) hospitalization is associated with in-hospital mortality, but there are limited data regarding its relation to long-term outcomes after discharge. The influence of WRF resolution is also unknown. This retrospective study analyzed patients who received care from a large health system and had a primary hospital discharge diagnosis of HF from January 2000 to June 2008. Renal function was estimated from creatinine levels during hospitalization. The first available value was considered baseline. WRF was defined a creatinine increase ≥ 0.3 mg/dl on any subsequent hospital day compared to baseline. Persistent WRF was defined as having WRF at discharge. Proportional hazards regression, adjusting for baseline renal function and potential confounding factors, was used to assess time to rehospitalization or death. Of 2,465 patients who survived to discharge, 887 (36%) developed WRF. Median follow-up was 2.1 years. In adjusted models, WRF was associated with higher rates of postdischarge death or rehospitalization (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.02 to 1.22). Of those with WRF, 528 (60%) had persistent WRF, whereas 359 (40%) recovered. Persistent WRF was significantly associated with higher postdischarge event rates (HR 1.14, 95% CI 1.02 to 1.27), whereas transient WRF showed only a nonsignificant trend toward risk (HR 1.09, 95% CI 0.96 to 1.24). In conclusion, in patients surviving hospitalization for HF, WRF was associated with increased long-term mortality and rehospitalization, particularly if renal function did not recover by the time of discharge.
The American journal of cardiology 01/2011; 107(1):74-8. · 3.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study compared the prevalence of high-risk cardiovascular (CV) conditions, antihypertensive medication treatment patterns, and demographic and clinical characteristics associated with blood pressure (BP) goal attainment between elderly (65 years and older) and nonelderly (younger than 65 years) adults with hypertension. Retrospective cohort study was conducted using an electronic medical record database among patients receiving at least 1 antihypertensive medication. CV risk profiles were assessed by International Classification of Diseases, 9th Revision diagnosis codes. Treatment patterns were assessed by the number of antihypertensive medications prescribed. BP goal attainment was determined by the mean of the last 2 BP readings during 1 year of follow-up. Logistic regression estimated the odds of achieving BP goal. There were 61,355 nonelderly (mean age, 51.8 years) and 47,796 elderly (mean age, 73.2 years) patients in the study. Elderly patients had statistically significant higher levels of isolated systolic hypertension and complicated hypertension. Elderly patients had statistically significant higher levels of prescribing patterns characterized by multiple antihypertensive medications but statistically significant lower levels of BP goal attainment. Age 65 years and older, African American race, body mass index ≥30, and the presence of complicated hypertension were found to be statistically significant factors contributing to a lower likelihood of BP goal attainment. Despite aggressive antihypertensive treatment, elderly patients are less likely to achieve BP goals.
Journal of Clinical Hypertension 12/2010; 12(12):935-44. · 2.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: Renal impairment frequently accompanies heart failure (HF) and is a recognized independent risk factor for morbidity and mortality. Few data are available assessing the impact of worsening renal function (WRF) during hospitalization on health care resource use in patients with HF. Health Insurance Portability and Accountability Act-compliant, de-identified, clinical, laboratory, and economic data for patients admitted to a tertiary care medical center with a primary diagnosis of HF were extracted by MedMining and reviewed retrospectively by the authors. Patients were excluded if they had no previous HF or were admitted for acute coronary syndrome or coronary artery bypass grafting within 30 days of index hospitalization. WRF was defined as ≥ 0.3 mg/dl increase in serum creatinine from baseline at any time during hospitalization. Of 5,803 hospitalized patients with primary HF diagnosis, 827 patients (14%) fulfilled all prespecified inclusion and exclusion criteria (74 ± 14 years of age, 43% men, 98% white, admission serum creatinine 1.4 ± 0.9 mg/dl, estimated glomerular filtration rate < 90 ml/min/1.73 m(2) at admission in 83%). During index hospitalization, WRF was identified in nearly 33%. Compared to patients without WRF, those with WRF had greater prevalence of diabetes (54% vs 43%), lower estimated glomerular filtration rate (44 ± 30 vs 62 ± 35 ml/min/1.73 m(2)), higher serum potassium (4.3 ± 0.7 vs 4.2 ± 0.7 mEq/L), and higher B-type natriuretic peptide (845 ± 821 vs 795 ± 947 pg/ml) at baseline (all p values < 0.05). Patients developing WRF incurred higher total inpatient costs ($10,977, range 671 to 212,819, vs $7,820, range 697 to 269,797, p < 0.001) and longer hospital stay (8.2 ± 6.8 vs 5.7 ± 5.5 days, p < 0.001). In conclusion, occurrence of WRF during HF-related hospitalization is associated with higher hospitalization costs and longer hospital stay.
The American journal of cardiology 10/2010; 106(8):1139-45. · 3.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: Kidney disease is common among patients with heart failure, but relationships between worsening renal function (WRF) and outcomes after hospitalization for heart failure are poorly understood, especially among patients with preserved systolic function. We examined associations between WRF and 30-day readmission, mortality, and costs among Medicare beneficiaries hospitalized with heart failure.
We linked data from a clinical heart failure registry to Medicare inpatient claims for patients >or=65 years old hospitalized with heart failure. We defined WRF as a change in serum creatinine >or=0.3 mg/dL from admission to discharge. Main outcome measures were readmission and mortality at 30 days after hospitalization and total inpatient costs.
Among 20,063 patients hospitalized with heart failure, WRF was common (17.8%) and more likely among patients with higher baseline comorbidity and more impaired renal function. In unadjusted analyses, WRF was associated with similar subsequent mean inpatient costs (USD 3,255 vs USD 3,277, P = .2) but higher readmission (21.8% vs 20.6%, P = .01) and mortality (10.0% vs 7.2%, P < .001). The differences persisted after adjustment for baseline patient and hospital characteristics (hazard of readmission 1.10 [95% CI 1.02-1.18], hazard of mortality 1.53 [95% CI 1.34-1.75]). Associations of WRF with readmission and mortality were similar between patients with reduced and preserved systolic function.
Worsening renal function during hospitalization for heart failure is an independent predictor of early readmission and mortality in patients with reduced and preserved systolic function.
American heart journal 07/2010; 160(1):132-138.e1. · 4.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: We examined whether worsening renal function (RF) was associated with long-term mortality, readmission, and inpatient costs in Medicare beneficiaries hospitalized with heart failure (HF). Baseline renal insufficiency in patients hospitalized for HF is associated with increased risk of morbidity and mortality. However, the relation between worsening RF and long-term clinical outcomes is unclear. We linked clinical registry data to Medicare inpatient claims to identify 1-year outcomes of patients > or =65 years of age hospitalized with HF. Worsening RF was defined as a change in serum creatinine > or =0.3 mg/dl. Relations between worsening RF and 1-year mortality and readmission were evaluated with multivariable Cox proportional hazards models with robust SEs; associations with inpatient costs were evaluated with generalized linear models with a log-link and Poisson distribution. Of 20,063 patients hospitalized with HF and discharged alive, 3,581 (17.8%) had worsening RF during the index hospitalization. One year after discharge, 35.4% of these patients died, 64.5% were readmitted, and average costs at 1 year were $14,829 (interquartile range 0 to 19,366). After adjustment for patient characteristics, baseline RF, and comorbid conditions, worsening RF was independently associated with 1-year mortality (hazard ratio 1.12, 95% confidence interval 1.04 to 1.20) but not readmission or total inpatient costs. In conclusion, worsening RF in patients hospitalized with HF was independently associated with long-term mortality.
The American journal of cardiology 06/2010; 105(12):1786-93. · 3.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: A retrospective cohort study was conducted to evaluate the association between low high-density lipoprotein cholesterol (HDL-C) and/or elevated triglycerides (TG) and cardiovascular (CV) and/or cerebrovascular (CB) events among patients with elevated low-density lipoprotein cholesterol (LDL-C) despite statin treatment.
Patient demographics, clinical characteristics, laboratory data, and CV/CB events, were collected from the UK General Practice Research Database. Abnormal lipid levels were defined using US and European clinical guidelines. The association between the frequency of CV/CB events among patients with HDL-C/TG abnormalities versus patients with isolated low LDL-C was estimated using multivariate Cox proportional hazards regression.
Of 19,843 statin-treated patients, 6823 had elevated LDL-C despite therapy for a mean follow-up of 1.99+/-1.06 years. Among these patients, 3115 (45.7%) also had HDL-C/TG abnormalities. A total of 715 patients (10.5%) experienced CV/CB events. In statin-treated patients not at LDL-C goal, the relative risk of a vascular event was 24% higher in patients with HDL-C/TG abnormalities (HR=1.24, 95% CI: 1.06-1.46, p=0.006) than in patients without HDL-C/TG abnormalities. Additional variables that were associated with a significantly increased risk of CV/CB events included age (p<0.0001), gender (p=0.027), and medication possession ratio (p<0.0001), while diabetes mellitus (p<0.0001), hypertension (p<0.0001), 10-year Framingham risk score>30% (p=0.005), statin dose (p<0.0001), and LDL-C level at baseline (p<0.0001) were associated with a significantly decreased risk of CV/CB events.
Among statin-treated patients with elevated LDL-C from UK clinical practices, reduced HDL-C and/or elevated TGs were associated with a significantly increased relative risk of CV/CB events.
[show abstract][hide abstract] ABSTRACT: To determine the frequency of lipid testing and to identify the factors predictive of lipid-testing frequency over a 1-year period in patients beginning statin treatment.
Retrospective cohort study performed using the UK General Practice Research Database. The patients were selected if they were > or = 35 years of age, received first-ever statin between January 2000 and December 2004, had at least one total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), or triglyceride (TG) test conducted in the 1-year period before statin initiation, and had at least 1 year of follow-up data. The main outcome measures were TC, HDL-C, and TG testing frequencies in the year after initiating statins. Poisson regression was used to assess baseline factors associated with testing frequency for each lipid.
In the year after initiating statins, the patients received a mean (+/-SD) of 1.3 (+/-1.0) TC tests, 0.9 (+/-1.0) HDL-C tests, and 0.9 (+/-1.0) TG tests; however, 22.7%, 44.3%, and 39.1% of the patients did not receive any TC, HDL-C, and TG tests, respectively. In multivariate analyses, a high coronary heart disease (CHD) risk (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01-1.07) and elevated baseline TC (> or = 6.2 vs. < 5.0 mmol/L; OR 1.12; 95% CI 1.06-1.18) were significantly associated with greater TC testing frequency.
High risk of CHD and elevated baseline TC were associated with greater rates of TC testing in the year after statin initiation. Lack of TC testing in approximately one in five patients, and infrequent HDL-C and TG testing may be barriers to comprehensive lipid management.
Value in Health 06/2008; 11(5):933-8. · 2.19 Impact Factor
[show abstract][hide abstract] ABSTRACT: Low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs) are associated with an increased incidence of coronary heart disease (CHD). However, limited data are available about the prevalence of dyslipidemias related to LDL-C, HDL-C, and TGs among French patients treated with lipid-lowering agents.
This paper describes the prevalence of various types of dyslipidemias among patients treated with lipid-lowering agents in French general practice.
This was a cross-sectional, observational study conducted using retrospective data collection at the time of enrollment. Eligible patients were those treated pharmacologically for dyslipidemia in the Cegedim Strategic Data general practice network. Fasting lipid values and cardiovascular (CV) risk factors were gathered by investigators using an ad hoc questionnaire. European guidelines were used to define various types of dyslipidemias. Polytomous logistic regression was used to assess the associations between different dyslipidemias and diabetes mellitus, a history of CHD, and the number of CV risk factors.
A total of 946 patients had a complete lipid profile and valid data for determining CV risk status. The mean (SD) age of these patients was 64.0 (9.9) years, and 55.7% of the patients were men. At least 1 abnormality in LDL-C, HDL-C, or TGs was present in 791 (83.6 %) of the 946 patients. The rates of elevated LDL-C, low HDL-C, and elevated TGs were 73.2%, 16.9%, and 30.3%, respectively (these groups are not mutually exclusive). Among those who did not reach the LDL-C goal, 38.7% had dyslipidemias with low HDL-C, elevated TGs, or both. Compared with having a normal lipid profile, each additional CV risk factor increased the likelihood of the following types of dyslipidemias: low HDL-C and/or elevated TGs, but normal LDL-C (odds ratio [OR], 1.36; 95% CI, 1.03-1.79); elevated LDL-C and TGs, but normal HDL-C (OR, 1.58; 95% CI, 1.24-2.02); and all 3 lipid abnormalities (OR, 1.54; 95% CI, 1.10-2.14). Patients with diabetes had a similarly increased risk of mixed dyslipidemias, whereas patients with a history of CHD did not.
Among these patients treated with lipid-lowering agents, 38.7% had mixed dyslipidemias, including low HDL-C, elevated TGs, both low HDL-C and elevated TGs, or all 3 lipid abnormalities. Patients with a greater number of nonlipid CV risk factors or with diabetes had a significantly increased risk of mixed dyslipidemias involving elevated TGs and/or low HDL-C in addition to elevated LDL-C.