Table 2.
Multivariable Proportional Hazards Model of Follow‐up HF Hospitalization
| Independent Variable | Hazard Ratio (95% CI) | P Value |
|---|---|---|
| SAC/VAL cohort (ref.: ACEI/ARB cohort)a | 0.42 (0.23–0.79) | 0.007 |
| Health plan type, patient age (ref.: commercial, 18–64 y) | ||
| Medicare Advantage, 18 to 64 y | 2.48 (0.79–7.78) | 0.119 |
| Medicare Advantage, ≥65 y | 2.50 (0.89–7.08) | 0.084 |
| Male (ref.: female) | 0.65 (0.33–1.25) | 0.196 |
| Baseline comorbid conditions | ||
| Dyslipidemia | 0.63 (0.29–1.35) | 0.231 |
| Ischemic heart disease other than MI | 2.93 (1.13–7.61) | 0.027 |
| Diabetes mellitus (including complications) | 0.73 (0.37–1.46) | 0.377 |
| Atrial fibrillation | 1.67 (0.87–3.20) | 0.122 |
| Renal disease | 1.57 (0.76–3.23) | 0.224 |
| Chronic obstructive pulmonary disease | 0.68 (0.36–1.32) | 0.257 |
| Peripheral artery disease | 0.96 (0.43–2.17) | 0.924 |
| Cerebrovascular disease | 0.73 (0.27–1.95) | 0.529 |
| Pulmonary edema | 0.45 (0.17–1.17) | 0.103 |
| Asthma | 0.95 (0.41–2.19) | 0.906 |
| Pulmonary vascular disease | 0.85 (0.35–2.07) | 0.712 |
| Primary malignancy | 1.74 (0.74–4.12) | 0.205 |
| Liver disease | 1.38 (0.41–4.64) | 0.600 |
| Baseline symptoms | ||
| Shortness of breath | 2.27 (0.76–6.73) | 0.141 |
| Altered consciousness | 0.71 (0.33–1.54) | 0.383 |
| Tachycardia | 1.58 (0.85–2.94) | 0.145 |
| Edema and fluid overload | 1.68 (0.81–3.51) | 0.167 |
| Palpitations | 1.35 (0.62–2.95) | 0.454 |
| Baseline number of HF guideline‐recommended therapiesb (ref.: 0–1) | ||
| 2 | 5.77 (1.08–30.96) | 0.041 |
| 3 | 3.82 (0.75–19.56) | 0.108 |
| ≥4 | 6.27 (1.16–33.92) | 0.033 |
| Baseline CRT/ICD | 2.33 (1.18–4.57) | 0.014 |
| Baseline revascularization | 0.32 (0.07–1.38) | 0.125 |
| Baseline HF hospitalizations (ref.: 0) | ||
| 1 | 3.09 (1.24–7.74) | 0.016 |
| ≥2 | 11.22 (3.50–35.95) | <0.001 |
| Baseline all‐cause medical costsc (ref.: quintile 1) | ||
| Quintile 2 | 2.07 (0.78–5.50) | 0.147 |
| Quintile 3 | 1.14 (0.36–3.54) | 0.827 |
| Quintile 4 | 1.19 (0.41–3.42) | 0.751 |
| Quintile 5 | 0.68 (0.21–2.22) | 0.527 |
| Baseline all‐cause outpatient pharmacy costsc (ref.: quintile 1) | ||
| Quintile 2 | 0.61 (0.19–1.95) | 0.406 |
| Quintile 3 | 0.87 (0.30–2.51) | 0.789 |
| Quintile 4 | 1.77 (0.66–4.74) | 0.256 |
| Quintile 5 | 1.05 (0.36–3.01) | 0.931 |
ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin‐receptor blocker; CRT/ICD, cardiac resynchronization therapy+implantable cardioverter defibrillator; HF, heart failure; MI, myocardial infarction; ref., reference; SAC/VAL, sacubitril/valsartan.
a
Unadjusted results for HF hospitalization: hazard ratio=0.56; 95% CI, 0.33 to 0.94; P=0.030.
b
Guideline therapies include ACEI/ARB, evidence‐based beta blocker, mineralocorticoid receptor antagonist, hydralazine+isosorbide dinitrate, digoxin, and ivabradine.
c
Health plan–dependent quintiles; quintiles are ordered from 1 (lowest cost) to 5 (highest cost).