Background:Current guidelines recommend evaluation for underlying heart disease and reversible conditions for patients with new-onset heart failure (HF). There are limited data on contemporary testing for coronary artery disease (CAD) in patients with new-onset HF.Methods:We performed an observational cohort study using the Get With The Guidelines–Heart Failure registry linked to Medicare claims. All patients were aged ≥65 and hospitalized for new-onset HF from 2009 to 2015. We collected left ventricular ejection fraction (LVEF), prior HF history, and in-hospital CAD testing from the registry, as well as testing for CAD using claims from 90 days before to 90 days after index HF hospitalization.Results:Among 17 185 patients with new-onset HF, 6672 (39%) received testing for CAD, including 3997 (23%) during the index hospitalization. Testing for CAD differed by LVEF: 53% in HF with reduced EF (LVEF ≤40%), 42% in HF with borderline EF (LVEF, 41%–49%), and 31% in HF with preserved EF (LVEF ≥50%). After multivariable adjustment, patients who received testing for CAD, compared with those who did not, were younger and more likely to be male, have a smoking history, have hyperlipidemia, and have HF with reduced ejection fraction or HF with borderline ejection fraction (all P<0.05).Conclusions:The majority of patients hospitalized for new-onset HF did not receive testing for CAD either during the hospitalization or in the 90 days before and after. The rates of testing for CAD were higher in patients with LVEF ≤40% though remained low. These data highlight an opportunity to improve care by identifying appropriate candidates for optimal CAD medical therapy and revascularization.

中文翻译：

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新发心力衰竭老年患者的冠状动脉疾病检测：《遵循心力衰竭指南》的结果。


背景：当前指南建议对新发心力衰竭 (HF) 患者进行潜在心脏病和可逆病症评估。关于新发心力衰竭患者冠状动脉疾病 (CAD) 的当代检测数据有限。方法：我们使用与医疗保险索赔相关的“遵循指南 - 心力衰竭登记”进行了一项观察性队列研究。所有患者年龄均≥65岁，并于 2009 年至 2015 年间因新发心力衰竭住院。我们从登记处收集了左心室射血分数 (LVEF)、既往心力衰竭病史和院内 CAD 检测，并使用索赔进行 CAD 检测心衰住院前 90 天至心衰住院后 90 天。结果：在 17 185 名新发心力衰竭患者中，6 672 例（39%）接受了 CAD 检测，其中 3 997 例（23%）在指数住院期间接受了 CAD 检测。 CAD 测试因 LVEF 的不同而不同：EF 降低的 HF 中为 53%（LVEF ≤ 40%），EF 为临界值的 HF 为 42%（LVEF，41%–49%），EF 保留的 HF 中为 31%（LVEF ≥50） %）。经过多变量调整后，与未接受 CAD 检测的患者相比，接受 CAD 检测的患者更年轻，更有可能是男性，有吸烟史，患有高脂血症，并且患有射血分数降低的心力衰竭或射血分数临界的心力衰竭（所有P <0.05）。结论：大多数因新发心力衰竭住院的患者在住院期间或住院前后90天内均未接受CAD检测。 LVEF ≤ 40% 的患者的 CAD 检测率较高，但仍较低。这些数据强调了通过确定最佳 CAD 药物治疗和血运重建的合适候选者来改善护理的机会。