Journal of Cardiac Failure
Volume 15, Issue 3 , Pages 241-248, April 2009

Statin Therapy and Clinical Outcomes in Heart Failure: A Propensity-Matched Analysis

  • Maral Ouzounian, MD

      Affiliations

    • Heart & Stroke/Richard Lewar Centre for Excellence, University of Toronto, and Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
    • Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    • ,
  • Jack V. Tu, MD, PhD

      Affiliations

    • Heart & Stroke/Richard Lewar Centre for Excellence, University of Toronto, and Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
    • Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    • Divisions of General Internal Medicine and Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Peter C. Austin, PhD

      Affiliations

    • Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    • Departments of Public Health Sciences and Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
    • ,
  • Alice Chong, BSc

      Affiliations

    • Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    • ,
  • Peter P. Liu, MD

      Affiliations

    • Heart & Stroke/Richard Lewar Centre for Excellence, University of Toronto, and Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
    • Canadian Institutes of Health Research, Ottawa, Ontario, Canada
    • ,
  • Douglas S. Lee, MD, PhD

      Affiliations

    • Heart & Stroke/Richard Lewar Centre for Excellence, University of Toronto, and Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
    • Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    • Corresponding Author InformationReprint requests: Douglas S. Lee, MD, PhD, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave Rm G-106, Toronto, Ontario, M4N 3M5 Canada.

Received 2 May 2008; received in revised form 9 October 2008; accepted 21 October 2008. published online 24 December 2008.

Abstract 

Background

The influence of statin therapy in heart failure (HF) has been of considerable interest. The objective of this study was to determine if statins are associated with improved outcomes in patients discharged after hospitalization for HF.

Methods

Patients admitted to Ontario hospitals between 1999 and 2001 with HF were identified in the Enhanced Feedback For Effective Cardiac Treatment study. Propensity score methods were used to assess 5-year outcomes in the overall cohort as well as in 4 subgroups: those with coronary artery disease (CAD) or without (NoCAD), and those with preserved ejection fraction (HFPEF) or with reduced ejection fraction (HFREF). Of the 6451 HF patients, 1121 were discharged with a prescription for a statin.

Results

In propensity analysis stratified on matched pairs in a Cox proportional hazards model, statins were associated with improved mortality at 5 years overall (hazard ratio [HR] 0.85, P = .05) and in those with CAD (HR 0.79, P = .008). Similarly, statins were associated with lower risk of the combined end point in the CAD group (HR 0.85, P = .045).

Conclusions

Among patients with HF discharged from hospital, statin therapy was associated with improved outcomes, particularly in patients with CAD. Stratification by ejection fraction did not differentially impact the effect of statins in patients with HF.

Key Words: Health outcomes, heart failure, statins, therapy

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 The Institute for Clinical Evaluative Sciences is supported in part by a grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results and conclusions are those of the authors and no endorsement by the Ministry of Health and Long-Term Care or by the Institute for Clinical Evaluative Sciences is intended or should be inferred. This study was supported by an operating grant from the Canadian Institutes of Health Research (CIHR) and a CIHR Team Grant in Cardiovascular Outcomes Research. M. Ouzounian is supported by a 2007 Research Fellowship Award from the Heart Failure Society of America and the Tailored Advanced Collaborative Training in Cadiovascular Sciences program of the CIHR; J. V. Tu is a Career Investigator of the Heart & Stroke Foundation of Ontario and Canada Research Chair in Health Services Research; P. P. Liu holds the Heart & Stroke/Polo Chair Professor of Medicine and Physiology at the University Health Network, University of Toronto and is Scientific Director, Institute of Circulatory and Respiratory Health, CIHR; P. C. Austin is supported by a New Investigator Award from the CIHR; D. S. Lee is a clinician-scientist of the CIHR.

 A preliminary version of the data in this manuscript was presented at the Scientific Sessions of the American Heart Association, November 5, 2007, in Orlando, Florida.

PII: S1071-9164(08)01050-6

doi:10.1016/j.cardfail.2008.10.026

Journal of Cardiac Failure
Volume 15, Issue 3 , Pages 241-248, April 2009

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