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Article Title

Impact of Comorbidity Dyads on Heart Failure Treatment in Older Persons

Publication Date

4-30-2015

Keywords

aging, multiple chronic conditions

Abstract

Background/Aims: The vast majority of heart failure (HF) patients suffer from multiple noncardiac comorbid conditions that may have important implications for clinical management. We assessed the clinical effectiveness and safety associated with the use of beta-blocker therapy for patients in a HF-chronic lung disease dyad group, and the clinical effectiveness and safety associated with the use of angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) for patients in a HF-chronic kidney disease (CKD) dyad group.

Methods: We identified over 30,000 HF patients with a documented ejection fraction (EF) from four members of the Cardiovascular Research Network –– Kaiser Permanente Northern California, Colorado and Northwest, and Fallon Health-Meyers Primary Care Institute –– from January 1, 2005, through December 31, 2008. To be included in the cohort, patients had to have > 1 inpatient admission with primary diagnosis of HF and/or > 3 outpatient encounters with any diagnosis of HF. Outcomes of interest included: death, hospitalization due to heart failure, and hospitalization for any cause.

Results: Beta-blocker therapy was associated with a reduced risk for death among the overall group of HF-lung disease patients, and specifically for those with borderline or reduced EF. ACE/ARB therapy was associated with a reduced risk for death among the overall group of HF-CKD patients, and specifically for those with preserved and reduced EF. We did not detect a statistically significant association between beta-blocker use and hospitalization for HF or hospitalization for any cause among the overall group of HF-lung disease patients; however, there was a reduced risk observed in hospitalization from any cause for those with reduced EF. We did not detect a statistically significant association between ACE/ARB use and hospitalization for HF or hospitalization for any cause among the overall group of HF-CKD patients; however, there was a reduced risk observed in hospitalization for HF among those with borderline EF.

Discussion: The findings of this observational study may have clinical implications for the management of HF in patients with common comorbid conditions including chronic lung disease and chronic kidney disease.

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