NYMC Faculty Publications

Characteristics and Outcomes of Patients With Advanced Chronic Systolic Heart Failure Receiving Care at the Veterans Affairs Versus Other Hospitals: Insights From the Beta-Blocker Evaluation of Survival Trial (BEST)

Author Type(s)

Faculty

DOI

10.1161/CIRCHEARTFAILURE.114.001300

Journal Title

Circulation

First Page

17

Last Page

24

Document Type

Article

Publication Date

1-1-2015

Department

Medicine

Keywords

Adrenergic beta-Antagonists, Female, Follow-Up Studies, Heart Failure, Systolic, Hospitalization, Hospitals, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Stroke Volume, Survival Rate, Treatment Outcome, United States, United States Department of Veterans Affairs, Ventricular Function, Left

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND: Characteristics and outcomes of patients with heart failure and reduced ejection fraction receiving care at Veterans Affairs (VA) versus 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 heart failure and left ventricular ejection fraction ≤35%, 918 received care at VA hospitals, of which 98% (n=898) were male. Of the 1789 receiving care at non-VA hospitals, 68% (n=1216) were male. 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 end point of 2-year all-cause mortality (35% VA versus 32% non-VA; hazard ratio associated with VA hospitals, 1.09; 95% confidence interval, 0.94-1.26), which remained unchanged after adjustment for age and race (hazard ratio, 1.00; 95% confidence interval, 0.86-1.16) or multivariable adjustment, including cardiovascular morbidities (hazard ratio, 0.94; 95% confidence interval, 0.80-1.10). There was no between-group difference in cause-specific mortalities or hospitalizations. Chronic kidney disease, pulmonary edema, left ventricular ejection fraction < 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 ejection fraction < 20% were associated with higher mortality among non-VA hospital patients only; however, these differences from VA patients were not significant.

CONCLUSIONS: Patients with heart failure and reduced ejection fraction receiving care at VA hospitals were older and sicker; yet their risk of mortality and hospitalization was similar to younger and healthier patients receiving care at non-VA hospitals.

CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000560.

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