Scientific Poster Session IV: Late-Breaking Original Research

Late Breaking Original Research
  Tuesday, November 14, 2023
  08:30 AM–10:00 AM

Abstract

Introduction: Infection frequently accompanies acute heart failure (HF) and is associated with an increased risk of mortality and HF hospitalizations. Guideline-directed medical therapy (GDMT) is frequently changed during hospitalizations, and de-escalation of GDMT is associated with increased mortality and hospitalizations after discharge. Whether GDMT affects rehospitalization risk among patients with acute HF and a concomitant infection is unknown.

Research Question or Hypothesis: Escalation of GDMT is associated with decreased rehospitalizations among patients hospitalized with acute HF and concomitant infection.

Study Design: Retrospective cohort study

Methods: Patients hospitalized for acute HF from 2016 to 2020 were identified using data from Inovalon. This administrative claims database includes medical and prescription claims data from public and private payers. Patients were identified based on International Classification of Disease – 10th Edition and diagnosis-related group codes and stratified into two groups based on the presence of a concomitant infection. Propensity-score matching corrected imbalances in baseline covariates. The primary outcome was rehospitalization within 12 months of discharge. A Cox regression model was used to analyze the effect of change in GDMT use from prior-to-admission to discharge on the primary outcome in the cohort with a concomitant infection. The pre-specified alpha was 0.05. Statistical analyses were run in SPSS version 29.0.

Results: 26,648 matched patients were included in the analysis. Concomitant infection was associated with an increased rehospitalization risk. Among patients with a concomitant infection, change in GDMT significantly affected rehospitalization risk. Rehospitalization risk decreased when GDMT use escalated (HR 0.67, 95% CI (0.64-0.71)) at discharge and increased when GDMT was maintained (HR 1.17, 95% CI (1.12-1.23)) or de-escalated (HR 1.98, 95% CI (1.84-2.13)).

Conclusion: Escalation of GDMT was associated with decreased rehospitalization risk among patients hospitalized with acute HF and a concomitant infection.

Presenting Author

Joseph Van Tuyl Pharm.D., BCCP
St. Louis College of Pharmacy at UHSP in St. Louis

Authors

Joel Arackal PharmD
University of Health Sciences and Pharmacy in St. Louis

Sumaya Ased PharmD
SSM Health

Kebede Beyene MSc, PhD
St. Louis College of Pharmacy at UHSP

Minkyung Kim PharmD
St. Anthony Hospital

Brooke Gengler Pharm.D., BCCP
SSM Health Saint Louis University Hospital

Scott Micek PharmD
St. Louis College of Pharmacy at University of Health Sciences and Pharmacy in St. Louis

Deana Mikhalkova MD
SSM Health St. Louis University Hospital

Besu Teshome PharmD, MSc
St. Louis College of Pharmacy at University of Health Sciences and Pharmacy in St. Louis

Brett Venker PharmD
Roivant Sciences