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Association Between Coronary Artery Disease Testing in Patients with New-Onset Heart Failure and Heart Failure Readmission and Mortality

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Abstract

Background

In patients with new-onset heart failure (HF), coronary artery disease (CAD) testing remains underutilized. Whether widespread CAD testing in patients with new-onset HF leads to improved outcomes remains to be determined.

Objective

We sought to examine whether CAD testing, and its timing, among patients hospitalized with new-onset HF with reduced ejection fraction (HFrEF), is associated with improved outcomes.

Design

Retrospective cohort study.

Participants

Adult (≥ 18 years) non-pregnant patients with new-onset HFrEF hospitalized within one of 15 Kaiser Permanente Southern California medical centers between 2016 and 2021. Key exclusion criteria included history of heart transplant, hospice, and a do-not-resuscitate order.

Main Measures

Primary outcome was a composite of HF readmission or all-cause mortality through end of follow-up on 12/31/2022.

Key Results

Among 2729 patients hospitalized with new-onset HFrEF, 1487 (54.5%) received CAD testing. The median age was 66 (56–76) years old, 1722 (63.1%) were male, and 1074 (39.4%) were White. After a median of 1.8 (0.6–3.4) years, the testing group had a reduced risk of HF readmission or all-cause mortality (aHR [95%CI], 0.71 [0.63–0.79]). These results were consistent across subgroups by history of atrial fibrillation, diabetes, renal disease, myocardial infarction, and elevated troponin during hospitalization. In a secondary analysis where CAD testing was further divided to early (received testing before discharge) and late testing (up to 90 days after discharge), there was no difference in late vs early testing (0.97 [0.81–1.16]).

Conclusions

In a contemporary and diverse cohort of patients hospitalized with new-onset HFrEF, CAD testing within 90 days of hospitalization was associated with a lower risk of HF readmission or all-cause mortality. Testing within 90 days after discharge was not associated with worse outcomes.

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Data Availability:

Cheng-Wei Huang had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Acknowledgements:

The authors would like to thank Jiaxiao Shi with statistical consultation, John Sim with study consultation, and the Care Improvement Research Team (CIRT) for their support.

Funding

This research was supported by the Care Improvement Research Team (CIRT) of Kaiser Permanente Southern California.

Author information

Authors and Affiliations

  1. Department of Hospital Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Cheng-Wei Huang MD, Joon S. Park MD & Christopher C. Subject MD

  2. Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA

    Cheng-Wei Huang MD, Joon S. Park MD & Ming-Sum Lee MD, PhD

  3. Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Siamak Kohan MD & Nicole C. Baghdasaryan MD

  4. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    In-Lu Amy Liu MS, Janet S. Lee MS, Jessica D. Vallejo MS & Huong Nguyen PhD, RN

  5. Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Ming-Sum Lee MD, PhD

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Huang, CW., Kohan, S., Liu, IL.A. et al. Association Between Coronary Artery Disease Testing in Patients with New-Onset Heart Failure and Heart Failure Readmission and Mortality. J GEN INTERN MED 39, 747–755 (2024). https://doi.org/10.1007/s11606-023-08599-1

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