ADVERTISEMENT
Patients With Myelofibrosis Are at Higher Risk for Poor Cardiovascular Outcomes After Heart Failure Hospitalization
Patients with myeloproliferative neoplasms (MPN) are at high risk of cardiovascular (CV) disease, including heart failure (HF). Those with myelofibrosis in particular have a higher chance of experiencing HF. In a study presented at the 2023 ASH Annual Meeting & Exposition, Orly Leiva, MD, New York University Grossman School of Medicine, Boston, Massachusetts, and colleagues examined CV outcomes for patients with MPN (essential thrombocythemia [ET], polycythemia vera [PV], or MF) who were hospitalized for HF.
The authors completed a retrospective analysis using data from the National Readmission Database (NRD). They used ICD-10 codes to identify adult patients with a history of MPN who had a primary diagnosis of HF from 2017 and 2018 (N = 4632). Of these patients, 2639 had ET, 1109 had PV, and 884 had MF.
The primary outcome of the study was 90-day unplanned CV-related readmission, which included readmission for HF, arterial thrombotic event (ATE), or venous thromboembolism (VTE). The secondary outcomes included index hospitalization death and 90-day unplanned readmission of any cause. In order to calculate the propensity scores (PS) for estimating probability of MF, the researchers used non-parsimonious multivariable logistic regression that included all baseline patient characteristics examined. They also utilized PS weighting (PSW) to adjust for potential confounders.
Dr Leiva and colleagues compared the outcomes of the patients with MF to those with ET or PV. The standardized mean difference (SMD) was calculated for variables before and after PSW. The Cox Proportional Hazards Regression Model was used to estimate the hazard ratios (HR) for the patients’ 90-day readmission outcomes, and logistic regression was used to calculate odds ratio (OR) for estimating index hospitalization death.
The results showed that prior to PSW, patients with MF were older than those with ET/PV (mean age 77.7 vs 74.3 years). They were also less likely to be female compared to patients with ET/PV (44.9% vs 56.1%). In addition, patients with MF were more likely to have anemia (53.8% vs 47.2%), and less likely to have systolic HF (39.9% vs 46.1%) and cardiogenic shock (1.6% vs 3.4%) when compared to the ET/PV cohort.
Although the baseline characteristics between both groups were well balanced after PSW, MF was associated with an increased risk of 90-day CV readmission (HR 1.18, 95% CI 1.08-1.30), index hospitalization death (OR 1.67, 95% CI 1.38-2.01), and 90-day any-cause readmission (HR 1.26, 95% CI 1.17-1.35). MF was also associated with increased risk of 90-day HF readmission (HR 1.24, 95% CI 1.12-1.38) after PSW. However, it was not associated with an increased risk of ATE (HR 0.62, 95% CI 0.47-0.81) or VTE readmission (HR 0.72, 95% CI 0.43-1.19).
In general, the study found that patients with MPN who had HF had high rates of 90-day CV-related and any-cause readmissions. However, patients with MF had a higher risk of these readmissions vs those who were part of the ET/PV cohort. In addition, MF was associated with a higher risk of index HF hospitalization mortality compared to patients with ET or PV. The authors suggest that more research is needed to identify risk factors for adverse CV outcomes in patients with MPNs who have MF, and that CV risk management should be incorporated into the care of these patients.
Source: Leiva O, Alvarez-Cardona J, Brunner AM, How CJ, Hobbs GS. Myelofibrosis Is Associated with Poor Cardiovascular Outcomes after Heart Failure Hospitalization. Presented at: 2023 ASH Annual Meeting & Exposition; December 9-12, 2023; San Diego, CA, and virtual; Abstract 3203.
