Heart failure medication after a first hospital admission and risk of heart failure readmission, focus on beta-blockers and renin-angiotensin-aldosterone system medication: A retrospective cohort study in linked databases.

Autor: Kruik-Kollöffel WJ; Department of Clinical Pharmacy, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo and Hengelo, the Netherlands., van der Palen J; Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands.; Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, the Netherlands., Doggen CJM; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands., van Maaren MC; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands.; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands., Kruik HJ; Department of Cardiology, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo and Hengelo, the Netherlands., Heintjes EM; PHARMO Institute, Utrecht, the Netherlands., Movig KLL; Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands., Linssen GCM; Department of Cardiology, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo and Hengelo, the Netherlands.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Dec 22; Vol. 15 (12), pp. e0244231. Date of Electronic Publication: 2020 Dec 22 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0244231
Abstrakt: Background: This study assessed the association between heart failure (HF) medication (angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB), beta-blockers (BB), mineralocorticoid-receptor antagonists (MRA) and diuretics) and HF readmissions in a real-world unselected group of patients after a first hospital admission for HF. Furthermore we analysed readmission rates for ACEI versus ARB and for carvedilol versus β1-selective BB and we investigated the effect of HF medication in relation to time since discharge.
Methods and Findings: Medication at discharge was determined with dispensing data from the Dutch PHARMO Database Network including 22,476 patients with HF between 2001 and 2015. After adjustment for age, gender, number of medications and year of admission no associations were found for users versus non-users of ACEI/ARB (hazard ratio, HR = 1.01; 95%CI 0.96-1.06), BB (HR = 1.00; 95%CI 0.95-1.05) and readmissions. The risk of readmission for patients prescribed MRA (HR = 1.11; 95%CI 1.05-1.16) or diuretics (HR = 1.17; 95%CI 1.09-1.25) was higher than for non-users. The HR for ARB relative to ACEI was 1.04 (95%CI 0.97-1.12) and for carvedilol relative to β1-selective BB 1.33 (95%CI 1.20-1.46). Post-hoc analyses showed a protective effect shortly after discharge for most medications. For example one month post discharge the HR for ACEI/ARB was 0.77 (95%CI 0.69-0.86). Although we did try to adjust for confounding by indication, probably residual confounding is still present.
Conclusions: Patients who were prescribed carvedilol have a higher or at least a similar risk of HF readmission compared to β1-selective BB. This study showed that all groups of HF medication -some more pronounced than others- were more effective immediately following discharge.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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