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

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 re-hospitalization. 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.