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Pharmacotherapy Choice Is Associated with 2-Year Mortality for Patients with Heart Failure and Reduced Ejection Fraction

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Abstract

Introduction

Factors associated with mortality for patients with heart failure and reduced ejection fraction (HFrEF) are known; however, the association between initial pharmacotherapy (IPT) and mortality is unclear in real-world settings.

Methods

Using a retrospective design and claims database, 14,359 Medicare patients with HFrEF from August 2010 to July 2015 were identified. Index date was first HF claim. IPT was mono- or combo-angiotensin-converting enzyme inhibitor (ACEI), angiotensin II receptor blocker (ARB), beta-blocker (BB), hydralazine–nitrate (HN), and aldosterone antagonist (AA) within 1 year post-index. A multivariable time-dependent Cox model estimated associations between IPT and 2-year all-cause mortality.

Results

Patients’ median age was 76 (70–82) years; 45.1% were female. Within 1 month post-index, 61.4% had IPT, 6.1% started after the first month, and 32.4% had no IPT in the first year. Of IPTs, 47.5% were mono-vasodilators (ACEI, ARB or HN), 23.3% mono-vasodilator + BB, 16.9% mono-BB, and 3.5% triple therapy [(ACEI or ARB) + BB + (HN or AA)]. Two-year mortality rate was 27.9%. Compared to mono-vasodilator therapy, patients initiating triple therapy had 29.3% lower risk of 2-year mortality; those on mono-BB or no IPT had higher mortality risk.

Conclusion

IPT was associated with decreased 2-year mortality risk. Timely consideration of triple IPT therapies may be warranted once HFrEF diagnosis is confirmed.

Funding

Novartis Pharmaceuticals Corp. located in East Hanover, NJ, USA.

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Acknowledgements

This work, including journal processing fees, was supported by Novartis Pharmaceuticals Corp. located in East Hanover, NJ, USA. Employees of Novartis participated in the study design, research, manuscript creation, and decision to publish in collaboration with Comprehensive Health Insights employees. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. We thank Mary Costantino, PhD, and Neelam Davis, PharmD, employees of Comprehensive Health Insights, for medical writing assistance. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.

Disclosures

This research was conducted collaboratively between Novartis Pharmaceuticals Corp. and Comprehensive Health Insights, a subsidiary of Humana Inc. Dana Drzayich Antol is an employee of Comprehensive Health Insights, Inc. Richard DeClue is an employee of Comprehensive Health Insights, Inc. Adrianne Casebeer is an employee of Comprehensive Health Insights, Inc. Yong Li is an employee of Comprehensive Health Insights, Inc. Stephen Stemkowski is an employee of Comprehensive Health Insights, Inc. Adrianne Casebeer owns stock in Humana Inc. Yong Li owns stock in Humana Inc. Stephen Stemkowski owns stock in Humana Inc. Nancy M. Albert reports receiving consulting fee support from Novartis regarding this and other research projects and continuing medical education. Chun-Lan Chang is an employee of Novartis Pharmaceuticals Corp. and owns stock in Novartis AG.

Compliance with Ethics Guidelines

Prior to initiation of this study, approval was obtained from Schulman Associates institutional review board. This study conformed to the Helsinki Declaration of 1964, as revised in 2013, concerning human and animal rights, and Springer’s policy concerning informed consent has been followed. This article does not contain any new studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Cleveland Clinic Foundation, Cleveland, OH, USA

    Nancy M. Albert

  2. Comprehensive Health Insights, Louisville, KY, USA

    Dana A. Drzayich Antol, Richard W. DeClue, Adrianne Waldman Casebeer, Yong Li & Stephen Stemkowski

  3. Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

    Chun-Lan Chang

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Correspondence to Nancy M. Albert.

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Albert, N.M., Drzayich Antol, D.A., DeClue, R.W. et al. Pharmacotherapy Choice Is Associated with 2-Year Mortality for Patients with Heart Failure and Reduced Ejection Fraction. Adv Ther 34, 2345–2359 (2017). https://doi.org/10.1007/s12325-017-0618-4

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