Contemporary outpatient management of patients with worsening heart failure with reduced ejection fraction: Clinical outcome results from the CHART-HF study

Hanna K Gaggin; Stephen J Greene; Mo Zhou; Dominik Lautsch; Lori D Bash; Laurence Djatche; Yan Song; James Signorovitch; Andra S Stevenson; Robert O Blaustein; Javed Butler

doi:10.1016/j.ijcrp.2024.200278

Contemporary outpatient management of patients with worsening heart failure with reduced ejection fraction: Clinical outcome results from the CHART-HF study

Int J Cardiol Cardiovasc Risk Prev. 2024 May 6:21:200278. doi: 10.1016/j.ijcrp.2024.200278. eCollection 2024 Jun.

Authors

Hanna K Gaggin^{1

2}, Stephen J Greene^{3

4}, Mo Zhou⁵, Dominik Lautsch⁶, Lori D Bash⁶, Laurence Djatche⁶, Yan Song⁵, James Signorovitch⁵, Andra S Stevenson⁶, Robert O Blaustein⁶, Javed Butler^{7

8}

Affiliations

¹ Harvard Medical School, Boston, MA, USA.
² Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
³ Duke Clinical Research Institute, Durham, NC, USA.
⁴ Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
⁵ Analysis Group, Inc., Boston, MA, USA.
⁶ Merck & Co., Inc., Rahway, NJ, USA.
⁷ Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
⁸ Baylor Scott and White Research Institute, Dallas, TX, USA.

Abstract

Background: Based on available data from randomized clinical trials, patients with heart failure with reduced ejection fraction (HFrEF) and worsening HF events (WHFE) have substantial disease burden and poor outcomes. WHFE clinical outcome data in non-clinical trial patients, more representative of the US clinical practice, has not been demonstrated.

Methods and results: CHART-HF collected data from two complementary, non-clinical trial cohort with HFrEF (LVEF <45 %): 1) 1,000 patients from an integrated delivery network and 2) 458 patients from a nationwide physician panel. CHART-HF included patients with WHFE between 2017 and 2019 followed by an index outpatient cardiology visit ≤6 months, and patients without WHFE in a given year between 2017 and 2019, with the last outpatient cardiology visit in the same year as the index visit. Compared to patients without WHFE (after covariate adjustment, all p < 0.05), patients with WHFE had a greater risk of HF-related hospitalization (hazard ratio [HR]: 1.53-2.40) and next WHFE event (HR: 1.67-2.41) following index visits in both cohorts.

Conclusion: HFrEF patients with recent WHFE consistently had worse clinical outcomes in these non-clinical trial cohorts. Despite advances in therapies, unmet need to improve clinical outcomes in HFrEF patients with WHFE remains.

Keywords: Clinical outcomes; Heart failure with reduced ejection fraction; Real-world evidence; Worsening heart failure event.