(146) An Electronic Health Record Analysis Studying Differences in Medication Use Associated with Renal Impairment in Acute Heart Failure

Background: Patients with heart failure (HF) have one of the highest rates of (re)hospitalisation, often in light of congestion or worsening HF. Treatment changes during hospitalisation in patients with both HF and chronic kidney disease (CKD) are poorly characterised. Evidence suggests that HF patients with CKD are less likely to receive indicated cardiovascular (CV) risk-reducing medications than HF patients without CKD, likely due to concerns of worsening kidney function.

Objectives: In this study we characterise the medication use in patients with and without CKD during an acute HF hospitalisation in two hospital locations in Amsterdam.

Methods: Patients with HF from two Amsterdam University Medical Center locations were identified based on codes from the International Classification of Diseases (ICD) 9 or 10 between 1 January 2015 and 6 December 2023. Patients needed to have an eGFR measurement at admission and CKD was determined with ICD-9 or ICD-10 codes in combination with an eGFR measurement below 60 ml/min/1.73m2. We determined the administration of HF medication and calculated the proportion of days covered (PDC) during hospitalisation.

Results: In total, we identified 4,563 patients with HF and eGFR measurements at admission. Of these patients, 60% had an eGFR below 60 ml/min/1.73m2 at admission. The median eGFR was 40 ml/min/1.73m2 [interquartile range (IQR) 28-52] for patients with CKD and 79 ml/min/1.73m2 for patients without CKD [IQR 68-90]. Patients with CKD were more often women (45%) and on average 6 years older (median age 76 years [IQR 68-83]) than patients without CKD (41% women, median age 70 years [IQR 59-78]). Patients with CKD had lower diastolic blood pressure and heart rate compared to those without CKD, but BMI and systolic blood pressure were similar.
During hospitalization patients with CKD received significantly less ACE-inhibitors than those with CKD (9%, 33% vs 42% respectively). Other medication was more similar, with differences between 1-2%, for ARNi, ARB, beta-blockers, MRA and SGLT2-inhibitors compared to those without CKD. During hospitalisation, if a patient received ACE-inhibitor treatment, the PDC was 7% lower for patients with CKD versus those without CKD (60% vs 67% respectively).
Preliminary results show that both patients with and without CKD spend a median of 6 days in the hospital [IQR 1-12], however during follow-up, patients with CKD were 10% more often rehospitalised (32% versus 22% respectively) and more often did not survive (47% versus 29% respectively).

Conclusions: There is a difference in case mix between patients with and without CKD. ACE-inhibitors were less administered during hospitalisation, yet other HF medications were prescribed similarly in those with and without CKD.