Highlights
- •There is scarce data on whether routine follow-up testing reduces adverse events in adults with heart failure
- •Routine follow-up testing was associated with risk of hospitalization with kidney injury
- •Routine follow-up testing was not associated with risk of 30-day all-cause mortality
Abstract
Background
Current clinical practice guidelines recommend routine kidney function and serum potassium
testing within 30 days of initiating angiotensin-converting enzyme inhibitor (ACEi)
or angiotensin II receptor blocker (ARB) therapy. However, evidence is lacking on
whether routine follow-up testing reduces therapy-related adverse events in adults
with heart failure and if multimorbidity influences the association between laboratory
testing and these adverse events.
Methods
We conducted a retrospective cohort study among adults with heart failure from four
U.S. integrated healthcare delivery systems. Multimorbidity was defined using counts
of chronic conditions. Patients with outpatient serum creatinine (SCr) and potassium
tests in the 30 days after starting ACEi or ARB therapy were matched 1:1 to patients
without follow-up tests. We evaluated the association of follow-up testing with 30-day
all-cause mortality and hospitalization with acute kidney injury or hyperkalemia using
Cox regression.
Results
We identified 3,629 matched adults with heart failure initiating ACEi or ARB therapy
between January 1, 2005, and December 31, 2012. Follow-up testing was not significantly
associated with 30-day all-cause mortality (adjusted hazard ratio, (aHR) 0.45 [95%
CI, 0.14; 1.39]) and hospitalization with hyperkalemia (aHR 0.73 [95% CI, 0.33; 1.61]).
However, follow-up testing was significantly associated with hospitalization with
acute kidney injury (aHR, 1.40 [95% CI, 1.01; 1.94]). Interaction between multimorbidity
burden and follow-up testing was not statistically significant in any of the outcome
models examined.
Conclusions
Routine laboratory monitoring after ACEi or ARB therapy initiation was not associated
with risk of 30-day all-cause mortality or hospitalization with hyperkalemia across
the spectrum of multimorbidity burden in a cohort of heart failure patients.
Keywords
Abbreviations:
ACEi (Angiotensin-converting enzyme inhibitors), ARB (angiotensin II receptor blockers), CVRN (Cardiovascular Research Network), VDW (Virtual Data Warehouse), HCPCS (Healthcare Common Procedure Coding System), hd-PS (High-dimensional propensity score), KDIGO (Kidney Disease Improving Global Outcomes), SD (Standard deviations), IQR (Interquartile ranges), CI (Confidence intervals), aHR (Adjusted hazard ratio)To read this article in full you will need to make a payment
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