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

The American Journal of Cardiology
Tetsuo YamaguchiYuya Matsue

Abstract

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). F...Continue Reading

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Citations

Jun 21, 2019·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Kenji YoshiokaKenzo Hirao
Sep 17, 2019·Clinical Cardiology·Padmaraj Samarendra
Mar 14, 2020·Heart, Lung & Circulation·Yuya MatsueTakeshi Kitai
Feb 25, 2021·European Journal of Preventive Cardiology·Masaaki KonishiYuya Matsue
Jul 13, 2021·Circulation Journal : Official Journal of the Japanese Circulation Society·Keisuke KidaYuya Matsue
Sep 3, 2021·Journal of the American Heart Association·Kentaro JujoYuya Matsue
Aug 31, 2021·European Heart Journal Supplements : Journal of the European Society of Cardiology·Giuseppe Di TanoDomenico Gabrielli

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