背景:关于结果的当代数据很少,成本,在具有流行病学代表性的队列中,心力衰竭(hHF)住院后的治疗。
目的:该研究试图描述再住院,住院费用,使用指南指导的药物治疗(GDMT)(肾素-血管紧张素系统抑制剂,沙库巴曲/缬沙坦,β受体阻滞剂,盐皮质激素受体拮抗剂,和钠-葡萄糖协同转运蛋白-2抑制剂),和hHF后的死亡率。
方法:进化HF(心力衰竭患者使用达帕格列净和其他指导指导的医学治疗:基于次要数据的多国观察性研究)是一项观察性研究,使用来自日本电子健康记录或索赔数据源的数据进行纵向队列研究,瑞典,联合王国,和美国。包括在2018年至2022年之间首次出现hHF放电的成年人。每100例患者年(ERs)死亡和再住院的一年事件发生率(主要诊断为心力衰竭(HF),慢性肾脏病[CKD],心肌梗塞,中风,或外周动脉疾病)进行计算。对医院医疗费用进行了累积总结。累积GDMT使用使用Kaplan-Meier估计进行评估。
结果:在263,525名患者中,28%在hHF后的第一年内死亡(ER:28.4[95%CI:27.0-29.9])。再住院主要由HF(ER:13.6[95%CI:9.8-17.4])和CKD(ER:4.5[95%CI:3.6-5.3])驱动,而心肌梗死的ER,中风,和外周动脉疾病较低。医疗保健成本主要由HF和CKD驱动。在2020年至2022年之间,使用肾素-血管紧张素系统抑制剂,沙库巴曲/缬沙坦,β受体阻滞剂,盐皮质激素受体拮抗剂变化不大,而钠-葡萄糖协同转运蛋白-2抑制剂的摄取增加2至7倍。
结论:hHF再住院风险和费用高,GDMT的使用在出院后的一年变化不大,强调需要考虑更早和更多地实施GDMT,以管理风险和降低成本。
There are few contemporary data on outcomes, costs, and treatment following a hospitalization for heart failure (hHF) in epidemiologically representative cohorts.
This study sought to describe rehospitalizations, hospitalization costs, use of guideline-directed medical therapy (GDMT) (renin-angiotensin system inhibitors, sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors), and mortality after hHF.
EVOLUTION HF (Utilization of Dapagliflozin and Other Guideline Directed Medical Therapies in Heart Failure Patients: A Multinational Observational Study Based on Secondary Data) is an observational, longitudinal cohort study using data from electronic health records or claims data sources in Japan, Sweden, the United Kingdom, and the United States. Adults with a first hHF discharge between 2018 and 2022 were included. The 1-year event rates per 100 patient-years (ERs) for death and rehospitalizations (with a primary diagnosis of heart failure (HF), chronic kidney disease [CKD], myocardial infarction, stroke, or peripheral artery disease) were calculated. Hospital health care costs were cumulatively summarized. Cumulative GDMT use was assessed using Kaplan-Meier estimates.
Of 263,525 patients, 28% died within the first year post-hHF (ER: 28.4 [95% CI: 27.0-29.9]). Rehospitalizations were mainly driven by HF (ER: 13.6 [95% CI: 9.8-17.4]) and CKD (ER: 4.5 [95% CI: 3.6-5.3]), whereas the ERs for myocardial infarction, stroke, and peripheral artery disease were lower. Health care costs were predominantly driven by HF and CKD. Between 2020 and 2022, use of renin-angiotensin system inhibitors, sacubitril/valsartan, beta-blockers, and mineralocorticoid receptor antagonists changed little, whereas uptake of sodium-glucose cotransporter-2 inhibitors increased 2- to 7-fold.
Incident post-hHF rehospitalization risks and costs were high, and GDMT use changed little in the year following discharge, highlighting the need to consider earlier and greater implementation of GDMT to manage risks and reduce costs.