About one in six patients with heart failure with reduced ejection fraction (HFrEF) develop worsening HF within 18 months of initial HF diagnosis, according to a study published Feb. 25 in the Journal of the American College of Cardiology.

Javad Butler, MD, MPH, MBA, FACC, et al., linked data from medical records of 11,064 patients with HFrEF in ACC's PINNACLE Registry to pharmacy, private practice and hospital claims databases to assess incidence, clinical characteristics, treatment and outcomes.

The results show that of all 11,064 HFrEF patients, 16.7 percent developed worsening HF about 18 months after the initial HF diagnosis. African-Americans and patients age 80 and older were more likely to develop worsening HF. In addition, 100 percent of patients with worsening HF had at least one cardiac or noncardiac comorbidity, such as hypertension, coronary artery disease or atrial fibrillation.

In terms of treatment (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker and mineralocorticoid receptor antagonist), 42.4 percent of patients were on monotherapy, 43.4 percent were on dual therapy and 14.1 percent were on triple therapy at the time of HF worsening, with beta blockers being the most common treatment. After six months, 26 percent of patients were on monotherapy, 43.8 percent were on dual therapy and 16.7 were on triple therapy. Among patients with worsening HF, the two-year mortality rate was 22.5 percent.

According to the authors, HFrEF patients who develop worsening HF may not be receiving optimal treatment at the time or after HF worsening. Additional research is needed to determine the role and treatment of comorbidities in preventing worsening HF and the proportion of worsening HF that can be prevented by optimal treatment, they conclude.

In an editorial comment, Adam P. Bress, PharmD, MS, and Jordan B. King, PharmD, MS, note that moving forward, "more research is needed to better understand the effect of worsening HF on patient outcomes and medication use, and to test interventions aimed at optimizing pharmacotherapy in this population."

Keywords: Mineralocorticoid Receptor Antagonists, Incidence, Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, Registries, Comorbidity, Angiotensin Receptor Antagonists, Treatment Outcome, National Cardiovascular Data Registries, PINNACLE Registry

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