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 - 11/04/18
, Takeshi Kitai, MD, PhD b, c, Takamichi Miyamoto, MD a, Nobuyuki Kagiyama, MD d, Takahiro Okumura, MD, PhD e, Keisuke Kida, MD, PhD f, Shogo Oishi, MD g, Eiichi Akiyama, MD h, Satoshi Suzuki, MD, PhD i, Masayoshi Yamamoto, MD, PhD j, Junji Yamaguchi, MD a, Takamasa Iwai, MD a, Sadahiro Hijikata, MD a, Ryo Masuda, MD a, Ryoichi Miyazaki, MD a, Nobuhiro Hara, MD a, Yasutoshi Nagata, MD a, Toshihiro Nozato, MD a, Yuya Matsue, MD, PhD k, l, mAbstract |
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 β blocker [BB]) and its association with 1-year all-cause mortality and HF 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.
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| REALITY-AHF was funded by The Cardiovascular Research Fund, Tokyo, Japan. |
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| Authors' contributions: Drs. Yamaguchi and Matsue were involved in conception and design of the study, data analysis, interpretation of data analysis, manuscript drafting, and manuscript review; Drs. Kagiyama, Miyamoto, Okumura, Kida, Oishi, and Akiyama, in study conception and design and data analysis; Drs. Suzuki, Yamamoto, Yamaguchi, Iwai, and Hijikata, in manuscript critical review; Drs. Masuda, Miyazaki, Hara, Nagata, and Nozato, in final approval of the manuscript. |
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| See page 973 for disclosure information. |
Vol 121 - N° 8
P. 969-974 - avril 2018 Retour au numéro
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