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Purpose: This study was undertaken to describe the heart failure (HF) population in an inner city, safety-net hospital and identify characteristics in this patient population that could impact pharmacotherapy.
Methods: This retrospective cohort study selected HF patients discharged over a one year period with a primary discharge diagnosis code of ICD-9 CM 428.xx. The following information was extracted: admit and discharge dates, demographics, imaging results, etiology, diagnostic testing, discharge medications, cardiology consult, BNP level, the presence of 90 day all-cause or cardiovascular readmissions and comorbidities. Demographic items were analyzed and reported as means +/- standard deviation. Comparison between data was made using student’s t-test for continuous variables and c2 test for nominal or ordinal items. Multivariate logistic regression was employed to identify predictors of 90 day readmission.
Results: 240 patients with 328 unique hospitalizations were examined. The sample of 240 patients had a mean age of 57.0 ± 12.5 years, and were mostly female (n=124, 51.7%) and African-American (AA) (n=192, 80%). Patients averaged 1.4 hospitalizations over the 1 year study period, with an average length of stay of 3.95 ± 3.27 days. Diastolic dysfunction was common in this population (n=114, 80%), etiology was mostly non-ischemic cardiomyopathy (n=119/217, 54.8%), and the average ejection fraction was 35.7 ± 17.3%. Substance abuse (ICD-9 code 305.X) was a common comorbid condition (n=97, 40%). Most patients were prescribed angiotensin converting enzyme inhibitors or angiotensin receptor blockers (n=188, 81.7%), beta blockers (N=179, 77.8%), and loop diuretics (n=173, 75%) at discharge. In contrast, most patients did not have aldosterone antagonists (n=43, 18.8%) or digoxin (n=33, 14.4%) prescribed at discharge.
Conclusion: This study illustrates patients discharged from an inner city safety-net hospital are mostly AA and have a high prevalence of non-ischemic etiology and substance abuse which should be considered when selecting pharmacotherapy.