Feature and impact of guideline-directed medication prescriptions for heart failure with reduced ejection fraction accompanied by chronic kidney disease
| Autor: | Hsiu-Yu Fang, Huang-Chung Chen, Chi-Ling Hang, Cheng-I Cheng, Chien-Hao Su, Morgan Fu, Po-Jui Wu, Yen-Nan Fang, Yung-Lung Chen, Shyh-Ming Chen |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Adrenergic beta-Antagonists Renal function Angiotensin-Converting Enzyme Inhibitors Comorbidity urologic and male genital diseases Drug Prescriptions Severity of Illness Index Angiotensin Receptor Antagonists 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans heart failure with reduced ejection fraction Prospective Studies Renal Insufficiency Chronic Aged Mineralocorticoid Receptor Antagonists Aged 80 and over Heart Failure Ejection fraction business.industry Cardiovascular Agents Stroke Volume General Medicine Middle Aged medicine.disease guideline-directed medications mortality Thyroid disorder female genital diseases and pregnancy complications Treatment Outcome Blood pressure Case-Control Studies Heart failure Practice Guidelines as Topic Propensity score matching Cohort Female 030211 gastroenterology & hepatology business chronic kidney disease Kidney disease Research Paper |
| Zdroj: | International Journal of Medical Sciences |
| ISSN: | 1449-1907 |
| Popis: | Background: With respect to total mortality and cardiovascular mortality, the feature and impact of guideline-directed medication (GDM) prescriptions for heart failure with reduced ejection fraction (HFrEF) with chronic kidney disease (CKD) are unknown. Therefore, we aimed to determine these aspects. Methods: GDM prescriptions and their impact on discharged patients with and without CKD were analyzed. To analyze differences in one-year clinical outcomes, propensity score matching was conducted on a cohort of patients with concomitant HFrEF and CKD who received more and fewer GDM prescriptions. Results: A total of 1509 patients were enrolled in Taiwan's HFrEF registry from May 2013 to October 2014, and 1275 discharged patients with complete one-year follow-up were further analyzed. Of these patients, 468 (36.7%) had moderate CKD, whereas 249 (19.5%) had advanced CKD. Patients with advanced CKD received fewer prescribed GDMs than other patients. Multivariate analysis revealed that peripheral arterial occlusive disease, thyroid disorder, advanced HF at discharge, diastolic blood pressure, digoxin use, and fewer prescribed GDMs were independent predictors of one-year total mortality. After propensity score matching, patients with fewer prescribed GDMs had higher one-year total mortality rate than those with more prescribed GDMs (P=0.036). Conclusions: CKD at discharge from HF hospitalization was associated with fewer GDM prescriptions, particularly in patients with more advanced CKD. The propensity-matched analysis indicated that more GDM prescriptions led to better clinical outcomes in HFrEF patients with CKD. Careful interpretation of changes in renal function during HF hospitalization may improve GDM prescriptions. |
| Databáze: | OpenAIRE |
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