Coronary Artery Disease Testing in New-Onset Heart Failure

Coronary artery disease (CAD) testing may be underutilized in patients hospitalized for new-onset heart failure, according to a new study published in the Journal of the American College of Cardiology.

Darshan Doshi, MD, MS, of Columbia University Medical Center/New York-Presbyterian Hospital in New York, and colleagues sought to determine patterns of ischemic testing and revascularization in this patient population. They conducted a retrospective cohort study using the Truven Health MarketScan Commercial and Medicare databases from 2010 to 2013.

“Many patients with HF [heart failure] also have concomitant coronary artery disease (CAD). The estimated prevalence of CAD with HF ranges from 50% to 65%,” they wrote. Therefore, identifying an underlying ischemic etiology of heart failure is essential for developing clinical management strategies.

Dr Doshi and colleagues studied 67 161 patients (mean age: 73.7 years; 52.4% male) with new-onset heart failure during inpatient hospitalization. Only 17.5% of these patients underwent testing for ischemic CAD during the index hospitalization, and 27.4% underwent testing at 90 days. Only 2.1% underwent revascularization during the index hospitalization, and by 90 days, the rate increased to 4.3%.

Stress testing (nuclear stress testing or stress echocardiography) was performed in 7.9% of patients with new-onset heart failure at index hospitalization, and in 14.6% of patients within 90 days. Coronary angiography, however, was performed in 11.1% of patients at the index hospitalization, and in 16.5% of patients within 90 days.

Patients with heart failure who carried a baseline diagnosis of CAD had greater odds of noninvasive ischemic testing, in an adjusted analysis (odds ratio [OR]: 1.25; 95% confidence interval [CI]: 1.17-1.33; P<.0001). These patients also had better odds of invasive ischemic testing (OR: 1.93; 95% CI: 1.83-2.05; P<.0001) at index hospitalization vs those without baseline CAD.

“The principal finding of this analysis was that almost three-quarters of patients with new-onset HF did not receive any ischemic CAD testing within 90 days of index admission,” Dr Doshi and colleagues wrote. “This finding was particularly striking given how prevalent CAD is among patients with HF, as well as in light of the adverse outcomes with concomitant CAD and HF.”

The authors concluded that additional research is necessary to determine why guideline-recommended diagnostic evaluations are not being performed in this patient population, and to develop measures that will enhance the detection of potentially reversible causes of new-onset heart failure.

Disclosures: Dr Doshi received an education grant from Abiomed. Other study authors have also received financial support from the pharmaceutical industry.

Reference

Doshi D, Ben-Yehuda O, Bonafede M, et al. Underutilization of coronary artery disease testing among patients hospitalized with new-onset heart failure. J Am Coll Cardiol. 2016;68(5):450-458. doi: 10.1016.j.jacc.2016.05.060.