Prognosis, characteristics, and provision of care for patients with the unspecified heart failure electronic health record phenotype: a population-based linked cohort study of 95262 individuals
Key result
Unspecified heart failure phenotype linked to ~66% higher risk of HF hospitalization or death versus HFrEF.
- HR 1.66
- 95% CI 1.59-1.74
- n=95,262
Why the study?
It was unknown whether the accuracy of heart failure phenotype ascribed to patients in electronic health records is associated with variation in prognosis and care provision.
Does an unspecified heart failure phenotype in electronic health records worsen clinical outcomes and care provision compared to specified HF phenotypes in patients with a new diagnosis of HF?
Population
95,262 individuals aged 16 years and older with newly diagnosed HF in England
Comparison
Unspecified HF vs HFpEF vs HFrEF recorded phenotypes
Design
Population-based linked cohort study
Authors
Discussion
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Member takes
Implication
Unspecified HF phenotypes in EHRs signal higher risk and undertreatment; leaves open whether better phenotyping improves outcomes in new HF.
Key Points
- To determine whether the specificity of heart failure phenotypes recorded in electronic health records is associated with differences in diagnostic investigations, pharmacological treatment, and clinical outcomes.
- Linked primary and secondary care electronic health records from the Clinical Practice Research Datalink in England (N=95,262 individuals aged ≥16 years with incident heart failure between 1998 and 2022).
- Categorized individuals into heart failure with preserved ejection fraction (HFpEF), reduced ejection fraction (HFrEF), or unspecified heart failure.
- Evaluated guideline-directed testing, medication prescription within 12 months, and composite hospitalization or mortality using Kaplan-Meier analyses and Cox proportional hazards regression models.
- Among 95,262 individuals, 87.3% (n=83,198) had unspecified heart failure, 11.3% (n=10,793) had HFrEF, and 1.3% (n=1,271) had HFpEF.
- Compared to HFrEF, patients with unspecified heart failure were less likely to receive ACE inhibitors (RR 0.64, 95% CI 0.63–0.64), beta blockers (RR 0.59, 95% CI 0.58–0.60), or mineralocorticoid receptor antagonists (RR 0.57, 95% CI 0.55–0.59) within 12 months.
- Unspecified heart failure was associated with higher risks of composite heart failure hospitalization or death (adjusted HR 1.66, 95% CI 1.59–1.74), all-cause mortality (adjusted HR 2.00, 95% CI 1.90–2.10), and cardiovascular death (adjusted HR 1.77, 95% CI 1.65–1.90) compared to HFrEF.
Study Design
Type
Cohort (n=95,262)
Multicenter
Yes
Structured PICO
Does an unspecified heart failure phenotype in electronic health records worsen clinical outcomes and care provision compared to specified HF phenotypes in patients with a new diagnosis of HF?
P
Population
95,262 individuals aged 16 years and older with a new diagnosis of heart failure between January 2, 1998 and February 28, 2022 from linked primary and secondary care records in the Clinical Practice Research Datalink in England.
I
Intervention
Unspecified heart failure phenotype in electronic health records
C
Comparator
Specified heart failure phenotype (HFrEF or HFpEF)
O
Outcome
Composite of HF hospitalisation or all-cause deathcomposite
Main Result
Effect estimate: HR 1.66 (95% CI 1.59-1.74)
Patients with an unspecified heart failure phenotype in electronic health records receive fewer guideline-recommended investigations and treatments, and have significantly worse survival compared to those with specified phenotypes.
Cite This Study
Nakao et al. (2023) conducted a cohort in Heart failure (n=95,262). Unspecified heart failure phenotype vs. Heart failure with reduced ejection fraction (HFrEF) was evaluated on Composite of heart failure hospitalisation or all-cause death (HR 1.66, 95% CI 1.59-1.74). An unspecified heart failure phenotype in electronic health records was associated with a higher risk of heart failure hospitalization or death compared to HFrEF (adjusted HR 1.66; 95% CI 1.59-1.74).