Heart Failure Drug Class Effects on 30-Day Readmission Rates in Patients with Heart Failure with Preserved Ejection Fraction: A Retrospective Single Center Study.

Priyanka Parajuli,Abhishek Kulkarni,Warren Skoza,Robert Robinson,Odalys Lara-Garcia,Mukul Bhattarai,Manjari Regmi

doi:10.3390/medicines7050030

Abstract

Background: The pharmacologic management of heart failure with preserved ejection fraction (HFpEF) involves far fewer options with demonstrated additional benefit. Therefore, we examined the effect of combination of multiple classes of HF medication in the 30-day hospital readmission in patients with HFpEF. Methods: All adult patients discharged with a diagnosis of HFpEF and a left ventricular ejection fraction (LVEF) of ≥ 50% reported during the admission or within the previous six months from our institution were retrospectively studied for a 30-day hospital readmission risk. Individual as well as combination drug therapy at the time of hospital discharge were evaluated using Pearson chi2 test and multivariate logistic regression. Results: The overall 30-day readmission rate in this HFpEF cohort of 445 discharges was 29%. Therapy with loop diuretics (p = 0.011), loop diuretics and angiotensin receptor blocker (p = 0.043) and loop diuretics and beta blockers (p = 0.049) were associated with a lower risk of 30-day hospital readmission. Multivariate logistic regression revealed only loop diuretics to be associated with a lower risk of hospital readmission in patients with HFpEF (OR 0.59; 95% CI, 0.39-0.90; p = 0.013). Conclusions: Our study revealed that loop diuretics at discharge decreases early readmission in patients with HFpEF. Further, our study highlights the implication of a lack of guidelines and treatment challenges in HFpEF patients and emphasizes the importance of a conservative approach in preventing early readmission in patients with HFpEF.

Highlights

Heart failure (HF) is a clinical syndrome affecting nearly six million Americans [1]
All adult patients discharged from the Southern Illinois University School of Medicine Hospitalist service with an International Classification of Disease (ICD), 10th Revision, Clinical Modification diagnosis of diastolic heart failure either as a primary or secondary diagnosis and an echocardiographic finding of left ventricular ejection fraction (LVEF) ≥ 50% reported within the previous six months of index hospitalization were studied for a 30-day readmission risk
Our study showed that diuretic therapy is an essential component of most therapeutic regimens for heart failure with preserved ejection fraction (HFpEF) and plays an especially critical role in decompensated and volume overloaded patients

Summary

Introduction

Heart failure (HF) is a clinical syndrome affecting nearly six million Americans [1]. Heart failure with preserved ejection fraction (HFpEF) is defined as a left ventricular ejection fraction (LVEF) greater than 50%, with the presence of a normal left ventricular end-diastolic volume (LVEDV) [2]. This clinical entity becomes increasingly prevalent with age, and is more common in women regardless of age [3]. Methods: All adult patients discharged with a diagnosis of HFpEF and a left ventricular ejection fraction (LVEF) of ≥ 50% reported during the admission or within the previous six months from our institution were retrospectively studied for a 30-day hospital readmission risk.

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