Effect of Optimizing Guideline-Directed Medical Therapy Before Discharge on Mortality and Heart Failure Readmission in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

Autor: Takamasa Iwai, Shogo Oishi, Tetsuo Yamaguchi, Takahiro Okumura, Takeshi Kitai, Ryoichi Miyazaki, Yuya Matsue, Takamichi Miyamoto, Sadahiro Hijikata, Keisuke Kida, Junji Yamaguchi, Satoshi Suzuki, Toshihiro Nozato, Masayoshi Yamamoto, Yasutoshi Nagata, Nobuhiro Hara, Ryo Masuda, Nobuyuki Kagiyama, Eiichi Akiyama
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Angiotensin-Converting Enzyme Inhibitors
030204 cardiovascular system & hematology
0302 clinical medicine
RANDOMIZED INTERVENTION TRIAL
030212 general & internal medicine
ELDERLY-PATIENTS
Metoprolol
Aged
80 and over
RISK
Ejection fraction
biology
Hazard ratio
Stroke volume
Middle Aged
Prognosis
Patient Discharge
Hospitalization
Practice Guidelines as Topic
Cardiology
SURVIVAL
Female
Guideline Adherence
Cardiology and Cardiovascular Medicine
medicine.drug
medicine.medical_specialty
Adrenergic beta-Antagonists
METOPROLOL
AMERICAN-COLLEGE
Patient Readmission
Angiotensin Receptor Antagonists
03 medical and health sciences
MORBIDITY
Internal medicine
medicine
Humans
ASSOCIATION TASK-FORCE
Mortality
Aged
Proportional Hazards Models
Heart Failure
Proportional hazards model
business.industry
Stroke Volume
Angiotensin-converting enzyme
medicine.disease
Confidence interval
Case-Control Studies
Heart failure
REGISTRY
biology.protein
business
MERIT-HF
Zdroj: American Journal of Cardiology, 121(8), 969-974. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
ISSN: 0002-9149
Popis: Guideline-directed medical therapy (GDMT) is recommended for patients with heart failure with reduced ejection fraction (HFrEF). However, the prognostic impact of medication optimization at the time of discharge in patients hospitalized with heart failure (HF) is unclear. We analyzed 534 patients (73 +/- 13 years old) with HFrEF. The status of GDMT at the time of discharge (prescription of angiotensin converting enzyme inhibitor [ACE-I]/angiotensin receptor blocker [ARB] and beta blocker [BB]) and its association with 1-year all-cause mortality and HT readmission were investigated. Patients were divided into 3 groups: those treated with both ACE-I/ARB and BB (Both group: n = 332, 62%), either ACE-I/ARB or BB (Either group: n = 169, 32%), and neither ACE-I/ARB nor BB (None group: n = 33, 6%), respectively. One-year mortality, but not 1-year HF readmission rate, was significantly different in the 3 groups, in favor of the Either and Both groups. A favorable impact of being on GDMT at the time of discharge on 1-year mortality was retained even after adjustment for covariates (Either group: hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.21 to 0.90, p = 0.025 and Both group: HR 0.29, 95% CI 0.13-0.65, p = 0.002, vs None group). For 1-year HF readmission, no such association was found. In conclusion, optimization of GDMT before the time of discharge was associated with a lower 1-year mortality, but not with HF readmission rate, in patients hospitalized with HFrEF. (C) 2018 Elsevier Inc. All rights reserved.
Databáze: OpenAIRE
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