Abstract 256: Optimal Medical Therapy Does Not Prevent Readmission in GWG-HF Patients with Ventricular Conduction Abnormalities

Abstract

Background: Conduction system abnormalities in heart failure (HF) patients have been associated with worse prognosis and higher mortality. Cardiac resynchronization has been successful in reducing readmission in patients with LBBB, but not other in ventricular conduction abnormalities. Effects of co-morbidities on readmission rates in HF patients with conduction abnormalities on and optimal, guideline directed medical therapy (OGDMT) were not well investigated. Methods: The study cohort included 2583 consecutive heart failure patients with sinus, non-paced rhythm (41.4% females, 65.2 ± 14.9 years old, EF 42.2% ± 14.1%) on modern medical therapy enrolled in Get With The Guidelines (GWTG) Registry at a single academic medical center. LBBB was noted in 7.6%, IVCD in 4.1%, and RBBB in 8.21%. Common comorbidities included HTN in 68.8%, CAD in 42.2%, DM in 38%, hyperlipidemia in 51.5%, and chronic lung disease in 24.5%. Results: The HF readmissions were significantly more common in patients with conduction abnormalities (21.2 vs. 15.4%, p=0.0016). Readmission rates were similar in patients with LBBB (20.9%), RBBB (21.2%) or nonspecific IVCD (21.5%). Patients with RBBB were older (70.5±14.8 vs. 63.9±14.7, p<0.01) Caucasian (81.1 vs. 71.5%, p<0.01) male (68.4 vs. 58.3%, p<0.01) with histories of CAD (51.4 vs. 40.2%, p<0.01), CVA/TIA (14.2 vs. 9.9%, p=0.04), hyperlipidemia (60.4 vs. 51.0%, p<0.01) and COPD or asthma (30.19%, p=0.04) despite fewer of them with history of smoking in last 12 months (21.2 vs. 31.5%, p=0.013). There was no difference between patients with RBBB and the rest of the cohort in utilization of ACE inhibitors, ARBs, or Hydralazine/Nitrates (77.1 vs. 82%, p=0.111), beta-adrenergic blockers (90.5 vs. 89.5%, p=0.625), or aldosterone receptor antagonists (19.6 vs. 19.5%, p=0.981). Conclusion: Ventricular conduction abnormalities are associated with increased risk of readmission in HF patients despite OGDMT. RBBB may serve as a surrogate marker for increased non-cardiac co-morbidity, where aggressive treatment of associated illness burden may translate in reduced readmission rates.