Characteristics and Outcomes of Patients with Advanced Chronic Systolic Heart Failure Receiving Care at the Veterans Affairs vs. Other Hospitals: Insights from the BEST Trial.
Circ Heart Fail. 2014 Dec 5;
Authors: Jones LG, Sin MK, Hage FG, Kheirbek RE, Morgan CJ, Zile MR, Wu WC, Deedwania P, Fonarow GC, Aronow WS, Prabhu SD, Fletcher RD, Ahmed A, Allman RM
Abstract
BACKGROUND: -Characteristics and outcomes of patients with heart failure and reduced ejection fraction (HFrEF) receiving care at Veterans Affairs (VA) vs. non-VA hospitals have not been previously reported.
METHODS AND RESULTS: -In the randomized controlled Beta-Blocker Evaluation of Survival Trial (BEST; 1995-1999), of the 2707 (bucindolol=1353; placebo=1354) patients with HFrEF (EF ≤35%), 918 received care at VA hospitals, of which 98% (n=898) were men. Of the 1789 receiving care at non-VA hospitals, 68% (n=1216) were men. Our analyses were restricted to these 2114 male patients. VA patients were older with higher symptom and comorbidity burdens. There was no significant between-group difference in unadjusted primary endpoint of 2-year all-cause mortality (35% VA vs. 32% non-VA; hazard ratio {HR}, 1.09; 95% confidence interval {CI}, 0.94-1.26), which remained unchanged after adjustment for age and race (HR, 1.00; 95% CI, 0.86-1.16) or multivariable-adjustment including cardiovascular morbidities (HR, 0.94; 95% CI, 0.80-1.10). There was no between-group differences in cause-specific mortalities or hospitalizations. Chronic kidney disease, pulmonary edema, left ventricular EF <20% and peripheral arterial disease were significant predictors of mortality for both groups. African America race, New York Heart Association class IV symptoms, atrial fibrillation and right ventricular EF <20% were associated with higher mortality among non-VA hospital patients only; however, these differences from VA patients were not significant.
CONCLUSIONS: -Patients with HFrEF receiving care at VA hospitals were older and sicker; yet their risk of mortality and hospitalization was similar to those younger and healthier receiving care at non-VA hospitals. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000560.
PMID: 25480782 [PubMed - as supplied by publisher]