Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
Por:
Tost, J, Llorens, P, Cotter, G, Davison, B, Jacob, J, Gil, V, Herrero, P, Martin-Sanchez, F, Donea, R, Rodriguez, B, Lucas-Imbernon, F, Andueza, J, Mecina, A, Torres-Garate, R, Pinera, P, Alquezar-Arbe, A, Espinosa, B, Mebazaa, A, Chioncel, O, Miro, O and ICA-SEMES Grp
Publicada:
1 dic 2021
Ahead of Print:
24 ago 2021
Resumen:
Aims: To analyze the frequency with which patients with heart failure with preserved ejection fraction (HFpEF) discharged after an acute heart failure (AHF) episode are treated with antineurohormonal drugs (ANHD), the variables related to ANHD prescription and their relationship with outcomes.
Methods: We included consecutive HFpEF patients (left ventricular ejection fraction >= 50%) discharged after an AHF episode from 45 Spanish hospitals whose chronic medications and treatment at discharge were available. Patients were classified according to whether they were discharged with or without ANHD, including beta-blockers (BB), renin-angiotensin-aldosterone-system inhibitors (RAASi) and mineralcorticosteroid-receptor antagonists (MRA). Co-primary outcomes consisted of 1-year all-cause mortality and 90-day combined adverse event (revisit to emergency department -ED-, hospitalization due to AHF or all-cause death). Secondary outcomes were 90-day adverse events taken individually. Adjusted associations of ANHD treatment with outcomes were calculated.
Results: We analyzed 3,305 patients with HFpEF (median age: 83, 60% women), 2,312 (70%) discharged with ANHD. The ANHD most frequently prescribed was BB (45.8%). The 1-year mortality was 26.9% (adjusted HR for ANHD patients:1.17, 95%CI=0.98-1.38) and the 90-day combined adverse event was 54.4% (HR=1.14, 95% CI=0.99-1.31). ED revisit was significantly increased by ANHD (HR=1.15, 95%CI=1.01-1.32). MRA and BB were associated with worse results in some co-primary or secondary endpoints, while RAASi (alone) reduced 90-day hospitalization (HR=0.73, 98%CI=0.56-0.96).
Conclusion: 70% of HFpEF patients are discharged with ANHD after an AHF episode. ANHD do not seem to reduce mortality or adverse events in HFpEF patients, only RAASi could provide some benefits, reducing the risk of hospitalization for AHF.
Filiaciones:
Tost, J:
Hosp Terrassa, Emergency Dept, Barcelona, Catalonia, Spain
:
Univ Miguel Hernandez, Emergency Dept, Short Stay Unit, Hosp Gen Alicante,Inst Invest Sanitaria & Biomed, Alicante, Spain
Univ Miguel Hernandez, Hospitalitat Home Unit, Hosp Gen Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Alicante, Spain
Cotter, G:
Momentum Res, Durham, NC USA
Davison, B:
Momentum Res, Durham, NC USA
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Catalonia, Spain
Gil, V:
Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Catalonia, Spain
Herrero, P:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Spain
Martin-Sanchez, F:
Univ Complutense, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Donea, R:
Hosp Terrassa, Emergency Dept, Barcelona, Catalonia, Spain
Rodriguez, B:
Hosp Univ Infanta Leonor, Emergency Dept, Madrid, Spain
Lucas-Imbernon, F:
Hosp Gen Albacete, Emergency Dept, Madrid, Spain
Andueza, J:
Univ Complutense, Hosp Gen Univ Gregorio Maranon, Emergency Dept, Madrid, Spain
Mecina, A:
Hosp AlcorcOn, Emergency Dept, Madrid, Spain
Torres-Garate, R:
Hosp Severo Ochoa, Emergency Dept, Madrid, Spain
Pinera, P:
Hosp Gen Univ Reina Sofia, Emergency Dept, Murcia, Spain
Alquezar-Arbe, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Catalonia, Spain
:
Univ Miguel Hernandez, Emergency Dept, Short Stay Unit, Hosp Gen Alicante,Inst Invest Sanitaria & Biomed, Alicante, Spain
Univ Miguel Hernandez, Hospitalitat Home Unit, Hosp Gen Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Alicante, Spain
Mebazaa, A:
St Louis & Lariboisiere Univ Hosp, AP HP, Dept Anaesthesiol & Crit Care Med, INSERM,U942, Paris, France
GREAT Network, Rome, Italy
Chioncel, O:
Prof CC Iliescu 1 Univ Med Carol Davila, Emergency Inst Cardiovasc Dis, Bucharest, Romania
Miro, O:
Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Catalonia, Spain
GREAT Network, Rome, Italy
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