학술논문

Testing for Coronary Artery Disease in Older Patients With New-Onset Heart Failure: Findings From Get With The Guidelines-Heart Failure.
Document Type
article
Source
Circulation: Heart Failure. 13(4)
Subject
atrial fibrillation
coronary artery disease
heart failure
hyperlipidemia
left ventricular dysfunction
Age Factors
Aged
Aged
80 and over
Coronary Artery Disease
Diagnostic Techniques
Cardiovascular
Female
Guideline Adherence
Heart Failure
Hospitalization
Humans
Male
Medicare
Practice Guidelines as Topic
Practice Patterns
Physicians
Predictive Value of Tests
Registries
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
United States
Ventricular Function
Left
Language
Abstract
BACKGROUND: Current guidelines recommend evaluation for underlying heart disease and reversible conditions for patients with new-onset heart failure (HF). There are limited data on contemporary testing for coronary artery disease (CAD) in patients with new-onset HF. METHODS: We performed an observational cohort study using the Get With The Guidelines-Heart Failure registry linked to Medicare claims. All patients were aged ≥65 and hospitalized for new-onset HF from 2009 to 2015. We collected left ventricular ejection fraction (LVEF), prior HF history, and in-hospital CAD testing from the registry, as well as testing for CAD using claims from 90 days before to 90 days after index HF hospitalization. RESULTS: Among 17 185 patients with new-onset HF, 6672 (39%) received testing for CAD, including 3997 (23%) during the index hospitalization. Testing for CAD differed by LVEF: 53% in HF with reduced EF (LVEF ≤40%), 42% in HF with borderline EF (LVEF, 41%-49%), and 31% in HF with preserved EF (LVEF ≥50%). After multivariable adjustment, patients who received testing for CAD, compared with those who did not, were younger and more likely to be male, have a smoking history, have hyperlipidemia, and have HF with reduced ejection fraction or HF with borderline ejection fraction (all P