Impact of Statin Therapy on Mortality and Rehospitalization in Acute Heart Failure Patients Stratified by Ejection Fraction: Insights from the Gulf CARE Registry

Abstract

Background: The prevalence and clinical outcomes of statin therapy in patients with acute heart failure AHF stratified by left ventricular ejection fraction EF in the Middle East are unknown. Methods: We analysed 5005 patients admitted to 47 hospitals in seven Middle Eastern countries Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain with AHF from February to November 2012 with AHF who were enrolled in Gulf CARE, a multinational registry of patients with heart failure HF. AHF patients were stratified into three groups: HF patients with reduced EF HFrEF <40%, HF with mildly reduced EF HFmrEF 40-49%, and HF patients with preserved EF HFpEF >= 50%. Results: The mean age of the cohort was 59.3 +/- 14.9 years, 62.6% n=3131.0 of the patients were males. A total of 2555 51% AHF patients had used statins prior to hospital admission. The mean EF was 36.9 +/- 14%. HFrEF was observed in 2683 patients 53%, whereas 961 patients 19.2% had HFmrEF, and 932 patients 18.6% had HFpEF. Multivariate logistic regression analysis revealed that prior statin use was significantly associated with reduced in-hospital mortality risk OR=1.43, 95% CI: 1.10-1.86, p=0.007 and hospitalization rates for heart failure OR=0.71, 95% CI: 0.60-0.83, p<0.001. However, when examining rates of survival, there were no significant disparities between the two groups; at 3 months follow-up: aOR, 1.22; 95% Cl: 0.95-1.57; P=0.111; and 12-months follow-up: aOR, 1.07; 95% Cl: 1.07 0.87-1.31; P=0.553. Regarding rehospitalization rates, no significant difference was observed at a 3- month follow-up: aOR, 1.22; 95% Cl: 1.03-1.42; P=0.015. Interestingly, patients admitted with statin therapy were significantly associated with higher odds of hospitalization during the 12-month follow-up period: aOR, 1.42; 95% Cl: 1.21-1.66; P<0.001. Conclusion: Prior statin use was associated with a lower risk of in-hospital mortality and rehospitalization. However, there were no significant differences in all-cause mortality between the two groups at both 3- and 12-month follow-ups. While rehospitalization rates at the 3-month follow-up showed higher odds of rehospitalization at the 12-month follow-up. Prior statin therapy appears to influence both in-hospital mortality and long-term rehospitalization outcomes in a Middle Eastern patient population.