TRANSLATE-HF: Gaps in Care Persist Among Patients with HFrEF and Comorbid CKD

Patrick Campbell

Hear from Muthiah Vaduganathan, MD, MPH, as he discusses the results of an analysis of data within the GWTG-HF registry that details gaps in care and management of heart failure patients with comorbid kidney disease.

The latest installment of the TRANSLATE-HF program is providing a comprehensive overview of the clinical profiles, therapy use, and outcomes among patients with heart failure with reduced ejection fraction (HFrEF) across the spectrum of kidney function.

Results of the analysis suggest eGFR distribution has undergone little change since 2014 and depict a risk-treatment paradox where patients with the most severe disease were the least likely to receive optimal medical therapy.

A series of registry studies using data obtained from the Get with the Guidelines-Heart Failure (GWTG-HF) registry, TRANSLATE-HF was designed to outline gaps in optimal treatment of patients with HFrEF. Created as an academic-industry collaboration by AstraZeneca and the Duke Clinical Research Institute, the latest study from the program was presented at the American College of Cardiology’s 70th Annual Scientific Session (ACC.21).

Performing a search of patients at 418 sites within the GWTG-HF registry from 2014-2019, investigators identified 365,494 patients for inclusion in their analysis. The study population had a mean age of 72±15 years, mean LVEF of 43±17%, and median eGFR of 51 (IQR, 34-72) mL/min/1.73m2 at discharge. Of the 365,494 included in the study, 234,332 had an eGFR less than 60 mL/min/1.73m2 and 18,869 (5%) were on dialysis.

Results of the investigators' analyses indicated contemporary trends in eGFR and rate of dialysis among the study population remained stable throughout the study period. Compared to those with an increased eGFR, patients with a lower eGFR were older, more likely to be women, more likely to be White. These patients also had higher rates of atrial fibrillation and diabetes.

Further analysis suggested the presence of a graded significant association between kidney function and in-hospital mortality. Additionally, an analysis of patient with an ejection fraction of 40% or less indicated use of guideline-directed medical therapies, including beta-blockers, was lowest among the subgroup of patients who were on dialysis.

For more insight into the ongoing TRANSLATE-HF program and the results of the current study, Practical Cardiology reached out to study investigator Muthiah Vaduganathan, MD, MPH, a cardiologist at Brigham and Women’s Hospital, and that conversation is the subject of this ACC.21 House Call.

This study, “Medical Therapies and Clinical Outcomes in HF Across the Kidney Function Spectrum: The Get With The Guidelines-Heart Failure (GWTG-HF) Registry,” was presented at ACC.21.