Table 3.
Patients with LVEF < 40%
| Treatment Patterns (ACEI, ARB, or BB)a | Treatment Patterns (Diuretic)a | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Increase (n = 36,478)b | No changes (n = 507,371) | Decrease (n = 34,091) | Rate Ratio for Treatment Increase | Rate Ratio for Treatment Decrease | No to Yes (n = 22,015) | No changes (n = 537,855) | Yes to No (n = 19,276) | Rate Ratio for Treatment Increase | Rate Ratio for Treatment Decrease | |
| NYHA class change, %c | ||||||||||
| Increase (n = 8452) | 8.1 | 83.8 | 7.8 | 1.5 | 1.3 | 6.1 | 89.8 | 4.0 | 1.9 | 1.1 |
| No changes (n = 156,801) | 5.5 | 88.3 | 6.0 | – | – | 3.3 | 93.2 | 3.5 | – | – |
| Decrease (n = 8370) | 7.7 | 85.1 | 7.1 | 1.4 | 1.2 | 4.5 | 91.9 | 3.7 | 1.4 | 1.1 |
| Dyspnea change, %c | ||||||||||
| No to yes (n = 20,833) | 14.5 | 80.4 | 4.8 | 2.5 | 0.9 | 9.2 | 88.0 | 2.8 | 2.6 | 0.9 |
| No changes (n = 435,120) | 5.8 | 88.6 | 5.4 | – | – | 3.6 | 93.3 | 3.2 | – | – |
| Yes to no (n = 13,026) | 4.3 | 83.8 | 11.6 | 0.7 | 2.2 | 2.7 | 92.2 | 5.1 | 0.8 | 1.6 |
| Orthopnea change, %c | ||||||||||
| No to yes (n = 10,720) | 13.4 | 82.0 | 4.5 | 2.2 | 0.8 | 8.7 | 88.5 | 2.8 | 2.4 | 0.8 |
| No changes (n = 463,734) | 6.0 | 88.1 | 5.7 | – | – | 3.7 | 93.0 | 3.3 | – | – |
| Yes to no (n = 7659) | 4.2 | 87.3 | 8.4 | 0.7 | 1.5 | 2.8 | 92.7 | 4.5 | 0.8 | 1.4 |
| Changes in signs, %c,d | ||||||||||
| Increase (n = 24,634) | 14.0 | 79.4 | 6.3 | 2.4 | 1.1 | 9.6 | 87.0 | 3.5 | 2.7 | 1.0 |
| No changes (n = 275,342) | 5.9 | 88.2 | 5.7 | – | – | 3.5 | 93.1 | 3.4 | – | – |
| Decrease (n = 18,282) | 5.5 | 85.5 | 8.6 | 0.9 | 1.5 | 3.3 | 91.8 | 4.9 | 0.9 | 1.4 |
N = visit pairings; individual patients often represented more than once
ACEI angiotensin-converting enzyme inhibitor, ARB angiotensin receptor blocker, BB beta blocker, NYHA New York Heart Association, LVEF left-ventricular ejection fraction
aTreatment patterns were grouped into 1 of 3 categories: ‘increase’ (no to yes), ‘decrease’ (yes to no), or ‘no change’ in number of HF medication classes (ACEI, ARB, BB, and diuretic therapies)
bUnit of analysis throughout the table is cardiology outpatient visits
cRow percentages do not add up to 100% as a small number of treatment pattern changes that could not be determined were observed
dChanges in number of physical signs of HF present out of 7 possible (rales, ascites, peripheral edema, hepatomegaly, third heart sound gallop, fourth heart sound gallop, jugular vein distension)