Guideline-Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure.
Pharmacotherapy. 2018 Feb 09;:
Authors: Tran RH, Aldemerdash A, Chang P, Sueta CA, Kaufman B, Asafu-Adjei J, Vardeny O, Daubert E, Alburikan KA, Kucharska-Newton AM, Stearns SC, Rodgers JE
BACKGROUND: Modification of guideline-directed medical therapy (GDMT) in hospitalized patients with heart failure (HF) has not been extensively evaluated.
METHODS: The community surveillance arm of the Atherosclerosis Risk in Communities Study identified 6959 HF hospitalizations from 2005 to 2011. Predictors of GDMT modification and survival were assessed using multivariable logistic regression and Cox proportional hazards models.
RESULTS: For 5091 hospitalizations, patient mean age was 75 years old, 53% were female, 69% were Caucasian, and 81% had acute decompensated HF (ADHF). Regarding ejection fraction (EF), 31% of patients had HF with reduced EF (HFrEF), 24% had HF with preserved EF (HFpEF), and 44% were missing EF values. At admission, 52% of cases received angiotensin-converting enzyme inhibitor/angiotensin-receptor blockers (ACEI/ARB), 66% β blockers (BB), 9% aldosterone-receptor antagonists, 16% digoxin, 10% hydralazine, and 29% nitrates. Modification of GDMT occurred in up to 23% of hospitalizations. Significant predictors of GDMT initiation included ADHF and HFrEF; discontinuation of medications was observed with select comorbidities. In HFrEF, initiation of any GDMT was associated with reduced 1-year, all-cause mortality (adjusted hazard ratio [HR]: 0.41; 95% confidence interval [CI]: 0.23-0.71) as was initiation of ACEI/ARB, BB, and digoxin. Discontinuation of any therapy versus maintaining GDMT was associated with greater mortality (HR: 1.30; 95% CI: 1.02-1.66). Similar trends were observed in HFpEF.
CONCLUSIONS: Our study suggests that GDMT initiation is associated with increased survival and discontinuation of therapy is associated with reduced survival in hospitalized patients with HF. Future studies should be conducted to confirm the impact of GDMT therapy modification in this population. This article is protected by copyright. All rights reserved.
PMID: 29423950 [PubMed - as supplied by publisher]