Management and Outcomes of Heart Failure with Preserved Systolic Function

Summary

Principal Investigator: Alan S Go
Abstract: This application addresses broad Challenge Area (04) Clinical Research and specific Challenge Topic, 04-HL- 105: Treatment of Heart Failure with Preserved Systolic Function Multiple advances in pharmacological and device therapies have been made to improve the care and outcomes for patients with heart failure and reduced left ventricular systolic function. However, the epidemiology of heart failure has been changing over the past several decades, with more than half of adults with clinically recognized heart failure syndromes currently having "preserved" left ventricular systolic function-typically defined as having a left ventricular ejection fraction of >50% or qualitative assessment of normal or preserved systolic function. Despite these changing trends and the expanding burden of heart failure, we have very few insights into any therapies that reduce the risk of premature death or heart failure exacerbation for patients with heart failure and preserved systolic function. Furthermore, we lack contemporary information on characteristics and event rates from diverse populations of patients who have heart failure with preserved systolic function that would help guide planning for future randomized clinical trials in these patients. To address these major knowledge gaps highlighted in NIH Challenge Topic 05-HL-105, we propose to leverage the National Heart, Lung and Blood Institute-sponsored Cardiovascular Research Network (CVRN), a multicenter, health plan-based research network that provides care for ~11 million members across the U.S. Through a collaboration of four participating CVRN centers, we propose to assemble a large, contemporary diverse cohort of adults with diagnosed heart failure and documented preserved left ventricular systolic function to examine the following three Specific Aims: Aim 1. To assemble a large, diverse multicenter cohort of adults with heart failure and documented preserved left ventricular systolic function between 2000-2008 and characterize recent practice patterns with available heart failure therapies. Aim 2. To determine contemporary rates and predictors of death, hospitalization for heart failure, and total resource utilization among adults with heart failure and preserved systolic function, overall and in targeted patient subgroups. Aim 3. Given the limited randomized clinical trial evidence in this population, to provide a preliminary evaluation of the effectiveness and safety of targeted therapies (i.e., ACE inhibitors, beta-blockers, and aldosterone receptor antagonists) that have been proven to be beneficial for patients with heart failure and reduced systolic function as well as exploring the outcomes associated with other commonly used therapies in chronic heart failure (e.g., diuretics, digoxin, nitrates, and statins). The public health burden for chronic heart failure is substantial-affecting 5.7 million Americans-the majority of whom are aged 65 years or older. More than half of patients with heart failure have preserved left ventricular systolic function, a condition whose prognosis remains poor and for which we have few randomized clinical trial data to guide therapy. The proposed study will provide critical and timely insights into contemporary adverse event rates and predictors of adverse outcomes, as well as into potential ways to improve the care and outcomes of the growing population of patients with heart failure and preserved systolic function.
Funding Period: ----------------2009 - ---------------2011-
more information: NIH RePORT

Top Publications

  1. pmc Patterns of comorbidity in older adults with heart failure: the Cardiovascular Research Network PRESERVE study
    Jane S Saczynski
    Meyers Primary Care Institute and Fallon Community Health Plan, Worcester, Massachusetts 01605, USA
    J Am Geriatr Soc 61:26-33. 2013
  2. pmc Comparison of medication practices in patients with heart failure and preserved versus those with reduced ejection fraction (from the Cardiovascular Research Network [CVRN])
    Robert J Goldberg
    Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
    Am J Cardiol 111:1324-9. 2013
  3. pmc Contemporary prevalence and correlates of incident heart failure with preserved ejection fraction
    Jerry H Gurwitz
    Meyers Primary Care Institute and Fallon Community Health Plan, Worcester, MA 01605, USA
    Am J Med 126:393-400. 2013
  4. pmc Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction
    David D McManus
    Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA 01655, USA
    J Am Heart Assoc 2:e005694. 2013
  5. pmc Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study
    David H Smith
    Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
    Circ Cardiovasc Qual Outcomes 6:333-42. 2013
  6. pmc Risk factors for adverse outcomes by left ventricular ejection fraction in a contemporary heart failure population
    Larry A Allen
    Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
    Circ Heart Fail 6:635-46. 2013
  7. pmc Natural history of left ventricular ejection fraction in patients with heart failure
    Christina L Clarke
    Kaiser Permanente Colorado Institute for Health Research, Denver
    Circ Cardiovasc Qual Outcomes 6:680-6. 2013
  8. pmc Guideline concordance of testing for hyperkalemia and kidney dysfunction during initiation of mineralocorticoid receptor antagonist therapy in patients with heart failure
    Larry A Allen
    Colorado Cardiovascular Outcomes Research Consortium, Denver
    Circ Heart Fail 7:43-50. 2014

Detail Information

Publications8

  1. pmc Patterns of comorbidity in older adults with heart failure: the Cardiovascular Research Network PRESERVE study
    Jane S Saczynski
    Meyers Primary Care Institute and Fallon Community Health Plan, Worcester, Massachusetts 01605, USA
    J Am Geriatr Soc 61:26-33. 2013
    ..To examine whether the total burden of comorbidity and pattern of co-occurring conditions varies in individuals with heart failure (HF) with preserved left ventricular ejection fraction (LVEF) (HF-P) or HF with reduced LVEF (HF-R)...
  2. pmc Comparison of medication practices in patients with heart failure and preserved versus those with reduced ejection fraction (from the Cardiovascular Research Network [CVRN])
    Robert J Goldberg
    Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
    Am J Cardiol 111:1324-9. 2013
    ..In conclusion, the present results from a large, population-based sample suggest considerable variation in the previous and new use of different cardiac medication classes of drugs in patients with HF-PEF versus HF-REF...
  3. pmc Contemporary prevalence and correlates of incident heart failure with preserved ejection fraction
    Jerry H Gurwitz
    Meyers Primary Care Institute and Fallon Community Health Plan, Worcester, MA 01605, USA
    Am J Med 126:393-400. 2013
    ....
  4. pmc Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction
    David D McManus
    Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA 01655, USA
    J Am Heart Assoc 2:e005694. 2013
    ..We examined how AF has impacts on adverse outcomes in HF-PEF versus HF-REF within a large, contemporary cohort...
  5. pmc Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study
    David H Smith
    Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
    Circ Cardiovasc Qual Outcomes 6:333-42. 2013
    ..There is scant evidence on the effect that chronic kidney disease (CKD) confers on clinically meaningful outcomes among patients with heart failure with preserved left ventricular ejection fraction (HF-PEF)...
  6. pmc Risk factors for adverse outcomes by left ventricular ejection fraction in a contemporary heart failure population
    Larry A Allen
    Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
    Circ Heart Fail 6:635-46. 2013
    ..The relative importance of common predictor variables for important clinical outcomes across strata of LVEF is relatively unknown...
  7. pmc Natural history of left ventricular ejection fraction in patients with heart failure
    Christina L Clarke
    Kaiser Permanente Colorado Institute for Health Research, Denver
    Circ Cardiovasc Qual Outcomes 6:680-6. 2013
    ..Such designations are not necessarily static, yet few data exist to describe the natural history of LVEF over time...
  8. pmc Guideline concordance of testing for hyperkalemia and kidney dysfunction during initiation of mineralocorticoid receptor antagonist therapy in patients with heart failure
    Larry A Allen
    Colorado Cardiovascular Outcomes Research Consortium, Denver
    Circ Heart Fail 7:43-50. 2014
    ..Guidelines recommend measurement of serum potassium (K) and creatinine (Cr) before and serially after MRA initiation, but the extent to which this occurs is unknown...