Prior HF, diabetes, polyvascular disease raise risk for HF hospitalization
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In patients with stable atherosclerotic CVD, those with prior HF were more than eight times more likely to be hospitalized for HF during follow-up, data show.
Also in that population, type 2 diabetes and polyvascular disease more than doubled the risk for HF hospitalization.
In an analysis of more than 26,000 adults participating in the TRA 2°P‐TIMI 50 trial, researchers also found that, at 3 years, outcomes among patients who experienced hospitalization for HF were poor; 30% required ICU admission and nearly 10% died.
“In patients with atherosclerotic vascular disease, we are appropriately concerned about adverse atherothrombotic events, such as MI and stroke,” Marc P. Bonaca, MD, MPH, FAHA, FACC, executive director of CPC Clinical Research, professor of cardiology and vascular medicine and director of vascular research at the University of Colorado School of Medicine, told Healio. “However, when these patients develop HF and are hospitalized for HF, their subsequent outcomes are poor and characterized by recurrent hospitalizations and death. Therefore, prevention of HF in this population should also be considered a priority. Then, of course, the question is who is at greatest risk for developing this complication. In the current analysis, data show it is those with prior HF, type 2 diabetes and those with peripheral artery disease and polyvascular disease.”
Assessing TIMI study data
Bonaca and colleagues analyzed data from 26,449 adults with stable ASCVD participating in the TRA 2°P‐TIMI 50 trial, a randomized, placebo-controlled trial assessing the (Zontivity, Xspire Pharma) in patients with an MI, stroke or symptomatic PAD before enrollment.
Researchers assessed HF hospitalization events; independent predictors of HF hospitalization risk were identified using logistic regression.
The estimated incidence of HF hospitalization at 3 years was 1.6%.
Prior HF was the largest predictor of HF hospitalization, with an adjusted OR of 8.31 (95% CI, 6.56-10.54), followed by type 2 diabetes (aOR = 2.55; 95% CI, 2.01-3.24), polyvascular disease (two‐territory disease, aOR = 1.89; 95% CI, 1.46-2.44; three‐territory disease, aOR = 2.68; 95% CI, 1.94-3.7), age (aOR per 10 years = 1.67; 95% CI, 1.47-1.89), chronic kidney disease (aOR = 1.65; 95% CI, 1.3-2.11), hypertension (aOR = 1.44; 95% CI, 1.02-2.04), prior MI (aOR = 1.35; 95% CI, 1.03-1.78) and BMI (aOR per 5 kg/m2 = 1.15; 95% CI, 1.03-1.27).
Participants who were hospitalized for HF during follow‐up had higher rates of subsequent rehospitalization and death, according to researchers.
Of the 353 patients who experienced an HF hospitalization, 30% required admission to an ICU and 8.8% died before leaving the hospital. By the end of follow‐up, CV and all‐cause death among patients who experienced a HF hospitalization event were 28% and 35%, respectively.
Vorapaxar did not modify the risk for HF hospitalization.
Importance of guideline-directed medical therapy
“It is clear that those with a history of HF should be treated according to current guidelines to prevent recurrent HF hospitalizations or death,” Bonaca told Healio. “For patients with diabetes and no history of HF, this underscores the importance of using therapies such as SGLT2 inhibitors to prevent HF. This was clearly shown in the DECLARE-TIMI 58 study, yet those therapies remain underutilized. We need implementation science to understand how to improve translation of those therapies.”
Bonaca said the observation that PAD and polyvascular disease are independently associated with increased risk for first HF hospitalization is novel.
“We need to understand more about the biology,” Bonaca said. “Is it in part that they are older, have more kidney disease and other comorbidities? This analysis says probably not since we adjusted for all of those factors. Perhaps there are direct biological factors, such as vascular stiffness, in those with severe systemic atherosclerosis which may directly promote HF. This is perhaps the most intriguing and exciting finding and suggests we should be studying HF in PAD and polyvascular disease and strategies to reduce the risk of developing HF.”
For more information:
Marc P. Bonaca, MD, MPH, FAHA, FACC, can be reached at marc.bonaca@cpcmed.org; Twitter: @marcbonaca.
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