Quality of care and outcomes among patients with heart failure and chronic kidney disease: A Get With the Guidelines—Heart Failure Program study
Received 23 December 2007; accepted 23 May 2008. published online 21 July 2008.
Background
Both heart failure (HF) and chronic kidney disease (CKD) are highly prevalent conditions that often coexist; however, the quality of care received by hospitalized patients with both is not known.
Methods
The Get With the Guidelines—HF registry and performance improvement program prospectively collects data on patients hospitalized with HF. Performance measures to improve treatment of patients with HF and inhospital mortality were examined by kidney function based on glomerular filtration rate (GFR) categorized as normal (GFR ≥ 90), mild (60 ≤ GFR < 90), moderate (30 ≤ GFR < 60), severe (15 ≤ GFR < 30), and kidney failure (GFR < 15 or dialysis).
Results
Nearly two thirds of hospitalized patients with HF (15,560 patients from 137 hospitals) also had CKD: moderate CKD (43.9%), severe CKD (14.2%), and kidney failure (6.6%). Inpatient mortality was higher for patients with more severe renal dysfunction. Those with kidney failure were significantly less likely to receive nearly all guidelines-based therapies. In contrast, those with moderate or severe CKD often received similar care when compared with those with normal kidney function, except for lower use of angiotensin-converting enzyme inhibitors or receptor blockers (odds ratio 0.19 [0.13-0.28] and 0.47 [0.36-0.62], respectively) and lower proportions with blood pressure control (odds ratio 0.70 [0.58-0.85] and 0.52 [0.42-0.63], respectively).
Conclusions
In a large contemporary cohort of patients hospitalized with HF, we found that renal dysfunction was a highly prevalent comorbidity. Despite higher mortality rates, patients with increased severity of renal dysfunction were less likely to receive important guideline-recommended therapies. Further efforts are needed to improve the care of patients with HF and CKD.
aDivision of Nephrology, Duke University Medical Center, Durham, NC
hAhmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, CA
Reprint requests: Uptal D. Patel, MD, Duke Clinical Research Institute, DUMC Box 3646, Nephrology, Durham, NC 27710.
Funding/Support: This study was funded by the American Heart Association (Dallas, TX) with support from an unrestricted educational grant from GlaxoSmithKline, Inc. (Philadelphia, PA) Doctor Patel is the recipient of grant K23 DK075929-01 from the National Institutes of Diabetes and Digestive and Kidney Diseases (Bethesda, MD). Doctor Hernandez is supported by an American Heart Association Pharmaceutical Roundtable grant 0675060N. Doctor Peterson is the recipient of grant R01 AG025312-01A1 from the National Institute on Aging (Bethesda, MD). Doctor Fonarow holds the Eliot Corday Chair of Cardiovascular Medicine and Science.
Presented in part at the American Heart Association Scientific Sessions 2006, Chicago, IL, November 12-15, 2006.
ABSTRACT