Heart failure in the outpatient versus inpatient setting: findings from the BIOSTAT-CHF study

João Pedro Ferreira, Marco Metra, Ify Mordi, John Gregson, Jozine ter Maaten, Jasper Tromp, Stefan D. Anker, Kenneth Dickstein, Hans L. Hillege, Leong L. Ng, Dirk J. van Veldhuisen, Chim C. Lang, Adriaan A. Voors, Faiez Zannad (Lead / Corresponding author)

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: Patients with symptomatic heart failure (HF) require additive therapies and have a poor prognosis. However, patient characteristics and clinical outcome between HF patients treated in the outpatient setting vs. those who are hospitalized remain scarce.

Methods and results: The BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) included 2516 patients with symptoms and/or signs of HF: 1694 as inpatients and 822 as outpatients. Compared to ambulatory HF patients, inpatients had higher heart rate, urea, N-terminal pro-brain natriuretic peptide, lower blood pressure, lower estimated glomerular filtration rate, sodium, potassium, high-density lipoprotein cholesterol, had more often peripheral oedema, diabetes, anaemia, and were less often treated with beta-blockers and angiotensin-converting enzyme inhibitors (ACEi). Outpatients had a more frequent history of HF hospitalization and received more frequently beta-blockers and/or ACEi/angiotensin receptor blockers up-titrated to target doses (P < 0.001). Inpatients had higher rates of the primary outcome of death or HF hospitalization: incidence rate per 100 person-years of 33.4 [95% confidence interval (CI) 31.1-35.9] for inpatients vs. 18.5 (95% CI 16.4-21.0) for outpatients; adjusted hazard ratio 1.24 (95% CI 1.07-1.43). Subdividing patients into low, intermediate and high-risk categories, the primary outcome event rates were 14.3 (95% CI 12.3-16.7), 36.6 (95% CI 32.2-41.5), and 71.3 (95% CI 64.4-79.0) for inpatients vs. 8.4 (95% CI 6.6-10.6), 29.8 (95% CI 24.5-36.2), and 43.3 (95% CI 34.7-54.0) for outpatients, respectively. These findings were externally replicated.

Conclusions: Marked differences were observed between inpatients and outpatients with HF. Overall, inpatients were sicker and had higher event rates. However, a substantial proportion of outpatients had similar or higher event rates compared to inpatients. These findings suggest that HF outpatients also have poor prognosis and may be the focus of future trials.

Original languageEnglish
Pages (from-to)112-120
Number of pages9
JournalEuropean Journal of Heart Failure
Volume21
Issue number1
Early online date19 Oct 2018
DOIs
Publication statusPublished - 1 Jan 2019

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Inpatients
Outpatients
Heart Failure
Confidence Intervals
Therapeutics
Angiotensin-Converting Enzyme Inhibitors
Hospitalization
Brain Natriuretic Peptide
Angiotensin Receptor Antagonists
Glomerular Filtration Rate
HDL Cholesterol
Signs and Symptoms
Urea
Anemia
Edema
Potassium
Heart Rate
Sodium
Blood Pressure
Incidence

Keywords

  • Entry criteria
  • Heart failure
  • Risk levels
  • Trials

Cite this

Ferreira, João Pedro ; Metra, Marco ; Mordi, Ify ; Gregson, John ; ter Maaten, Jozine ; Tromp, Jasper ; Anker, Stefan D. ; Dickstein, Kenneth ; Hillege, Hans L. ; Ng, Leong L. ; van Veldhuisen, Dirk J. ; Lang, Chim C. ; Voors, Adriaan A. ; Zannad, Faiez. / Heart failure in the outpatient versus inpatient setting : findings from the BIOSTAT-CHF study. In: European Journal of Heart Failure. 2019 ; Vol. 21, No. 1. pp. 112-120.
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abstract = "Introduction: Patients with symptomatic heart failure (HF) require additive therapies and have a poor prognosis. However, patient characteristics and clinical outcome between HF patients treated in the outpatient setting vs. those who are hospitalized remain scarce.Methods and results: The BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) included 2516 patients with symptoms and/or signs of HF: 1694 as inpatients and 822 as outpatients. Compared to ambulatory HF patients, inpatients had higher heart rate, urea, N-terminal pro-brain natriuretic peptide, lower blood pressure, lower estimated glomerular filtration rate, sodium, potassium, high-density lipoprotein cholesterol, had more often peripheral oedema, diabetes, anaemia, and were less often treated with beta-blockers and angiotensin-converting enzyme inhibitors (ACEi). Outpatients had a more frequent history of HF hospitalization and received more frequently beta-blockers and/or ACEi/angiotensin receptor blockers up-titrated to target doses (P < 0.001). Inpatients had higher rates of the primary outcome of death or HF hospitalization: incidence rate per 100 person-years of 33.4 [95{\%} confidence interval (CI) 31.1-35.9] for inpatients vs. 18.5 (95{\%} CI 16.4-21.0) for outpatients; adjusted hazard ratio 1.24 (95{\%} CI 1.07-1.43). Subdividing patients into low, intermediate and high-risk categories, the primary outcome event rates were 14.3 (95{\%} CI 12.3-16.7), 36.6 (95{\%} CI 32.2-41.5), and 71.3 (95{\%} CI 64.4-79.0) for inpatients vs. 8.4 (95{\%} CI 6.6-10.6), 29.8 (95{\%} CI 24.5-36.2), and 43.3 (95{\%} CI 34.7-54.0) for outpatients, respectively. These findings were externally replicated.Conclusions: Marked differences were observed between inpatients and outpatients with HF. Overall, inpatients were sicker and had higher event rates. However, a substantial proportion of outpatients had similar or higher event rates compared to inpatients. These findings suggest that HF outpatients also have poor prognosis and may be the focus of future trials.",
keywords = "Entry criteria, Heart failure, Risk levels, Trials",
author = "Ferreira, {Jo{\~a}o Pedro} and Marco Metra and Ify Mordi and John Gregson and {ter Maaten}, Jozine and Jasper Tromp and Anker, {Stefan D.} and Kenneth Dickstein and Hillege, {Hans L.} and Ng, {Leong L.} and {van Veldhuisen}, {Dirk J.} and Lang, {Chim C.} and Voors, {Adriaan A.} and Faiez Zannad",
note = "This project was funded by a grant from the European Commission(FP7-242209-BIOSTAT-CHF; EudraCT 2010–020808–29).",
year = "2019",
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doi = "10.1002/ejhf.1323",
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Ferreira, JP, Metra, M, Mordi, I, Gregson, J, ter Maaten, J, Tromp, J, Anker, SD, Dickstein, K, Hillege, HL, Ng, LL, van Veldhuisen, DJ, Lang, CC, Voors, AA & Zannad, F 2019, 'Heart failure in the outpatient versus inpatient setting: findings from the BIOSTAT-CHF study' European Journal of Heart Failure, vol. 21, no. 1, pp. 112-120. https://doi.org/10.1002/ejhf.1323

Heart failure in the outpatient versus inpatient setting : findings from the BIOSTAT-CHF study. / Ferreira, João Pedro; Metra, Marco; Mordi, Ify; Gregson, John; ter Maaten, Jozine; Tromp, Jasper; Anker, Stefan D.; Dickstein, Kenneth; Hillege, Hans L.; Ng, Leong L.; van Veldhuisen, Dirk J.; Lang, Chim C.; Voors, Adriaan A.; Zannad, Faiez (Lead / Corresponding author).

In: European Journal of Heart Failure, Vol. 21, No. 1, 01.01.2019, p. 112-120.

Research output: Contribution to journalArticle

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T1 - Heart failure in the outpatient versus inpatient setting

T2 - findings from the BIOSTAT-CHF study

AU - Ferreira, João Pedro

AU - Metra, Marco

AU - Mordi, Ify

AU - Gregson, John

AU - ter Maaten, Jozine

AU - Tromp, Jasper

AU - Anker, Stefan D.

AU - Dickstein, Kenneth

AU - Hillege, Hans L.

AU - Ng, Leong L.

AU - van Veldhuisen, Dirk J.

AU - Lang, Chim C.

AU - Voors, Adriaan A.

AU - Zannad, Faiez

N1 - This project was funded by a grant from the European Commission(FP7-242209-BIOSTAT-CHF; EudraCT 2010–020808–29).

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Patients with symptomatic heart failure (HF) require additive therapies and have a poor prognosis. However, patient characteristics and clinical outcome between HF patients treated in the outpatient setting vs. those who are hospitalized remain scarce.Methods and results: The BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) included 2516 patients with symptoms and/or signs of HF: 1694 as inpatients and 822 as outpatients. Compared to ambulatory HF patients, inpatients had higher heart rate, urea, N-terminal pro-brain natriuretic peptide, lower blood pressure, lower estimated glomerular filtration rate, sodium, potassium, high-density lipoprotein cholesterol, had more often peripheral oedema, diabetes, anaemia, and were less often treated with beta-blockers and angiotensin-converting enzyme inhibitors (ACEi). Outpatients had a more frequent history of HF hospitalization and received more frequently beta-blockers and/or ACEi/angiotensin receptor blockers up-titrated to target doses (P < 0.001). Inpatients had higher rates of the primary outcome of death or HF hospitalization: incidence rate per 100 person-years of 33.4 [95% confidence interval (CI) 31.1-35.9] for inpatients vs. 18.5 (95% CI 16.4-21.0) for outpatients; adjusted hazard ratio 1.24 (95% CI 1.07-1.43). Subdividing patients into low, intermediate and high-risk categories, the primary outcome event rates were 14.3 (95% CI 12.3-16.7), 36.6 (95% CI 32.2-41.5), and 71.3 (95% CI 64.4-79.0) for inpatients vs. 8.4 (95% CI 6.6-10.6), 29.8 (95% CI 24.5-36.2), and 43.3 (95% CI 34.7-54.0) for outpatients, respectively. These findings were externally replicated.Conclusions: Marked differences were observed between inpatients and outpatients with HF. Overall, inpatients were sicker and had higher event rates. However, a substantial proportion of outpatients had similar or higher event rates compared to inpatients. These findings suggest that HF outpatients also have poor prognosis and may be the focus of future trials.

AB - Introduction: Patients with symptomatic heart failure (HF) require additive therapies and have a poor prognosis. However, patient characteristics and clinical outcome between HF patients treated in the outpatient setting vs. those who are hospitalized remain scarce.Methods and results: The BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) included 2516 patients with symptoms and/or signs of HF: 1694 as inpatients and 822 as outpatients. Compared to ambulatory HF patients, inpatients had higher heart rate, urea, N-terminal pro-brain natriuretic peptide, lower blood pressure, lower estimated glomerular filtration rate, sodium, potassium, high-density lipoprotein cholesterol, had more often peripheral oedema, diabetes, anaemia, and were less often treated with beta-blockers and angiotensin-converting enzyme inhibitors (ACEi). Outpatients had a more frequent history of HF hospitalization and received more frequently beta-blockers and/or ACEi/angiotensin receptor blockers up-titrated to target doses (P < 0.001). Inpatients had higher rates of the primary outcome of death or HF hospitalization: incidence rate per 100 person-years of 33.4 [95% confidence interval (CI) 31.1-35.9] for inpatients vs. 18.5 (95% CI 16.4-21.0) for outpatients; adjusted hazard ratio 1.24 (95% CI 1.07-1.43). Subdividing patients into low, intermediate and high-risk categories, the primary outcome event rates were 14.3 (95% CI 12.3-16.7), 36.6 (95% CI 32.2-41.5), and 71.3 (95% CI 64.4-79.0) for inpatients vs. 8.4 (95% CI 6.6-10.6), 29.8 (95% CI 24.5-36.2), and 43.3 (95% CI 34.7-54.0) for outpatients, respectively. These findings were externally replicated.Conclusions: Marked differences were observed between inpatients and outpatients with HF. Overall, inpatients were sicker and had higher event rates. However, a substantial proportion of outpatients had similar or higher event rates compared to inpatients. These findings suggest that HF outpatients also have poor prognosis and may be the focus of future trials.

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