Midodrine use in HFrEF patients was independently associated with a 2.03-fold increased mortality risk after adjusting for comorbidities and GDMT (aOR 2.03; P<0.001).
Does midodrine use impact mortality and hospital readmission rates in adult patients with HFrEF?
In patients with HFrEF, the use of midodrine for blood pressure support during hospitalization is independently associated with a two-fold increased risk of all-cause mortality.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Midodrine, an alpha agonist drug, can be used to support blood pressure in heart failure patients with reduced ejection fraction (HFrEF). However, its impact on mortality in this population remains controversial. Purpose To evaluate the association between midodrine use and clinical outcomes, including mortality and hospital readmission rates, in patients with HFrEF. Methods A retrospective cohort study was conducted on adult patients diagnosed with HFrEF (left ventricular ejection fraction LVEF 40%) in Arizona between January 2020 and December 2021. The primary outcome was all-cause mortality among patients who received midodrine during the index hospitalization. Secondary outcomes included 30-day and 90-day hospital readmission rates. Results Of the 1,698 patients with HFrEF, 174 (10.25%) received midodrine. Midodrine use was associated with a significantly higher mortality risk (relative risk RR: 2.31; 95% confidence interval CI: 1.74–3.07; P 0.001). After adjusting for age, comorbidities and conventional guideline-directed medical therapy (GDMT), midodrine remained an independent predictor of increased mortality (adjusted odds ratio aOR: 2.03; 95% CI: 1.43–2.89; P 0.001). Conventional GDMT including Beta blocker and Angiotensinogen converting enzyme inhibitor/Angiotensin receptor blocker (ACEI/ARBs), and Mineralocorticoid receptor antagonist were associated with a significantly lower mortality rate. The use of midodrine was not associated with an increased risk of hospital readmission at 30 or 90 days post-discharge. Conclusion In patients with HFrEF, the use of midodrine was independently associated with increased mortality, even after adjusting for comorbid conditions and GDMT.
Mahar et al. (Sat,) reported a other. Midodrine use in HFrEF patients was independently associated with a 2.03-fold increased mortality risk after adjusting for comorbidities and GDMT (aOR 2.03; P<0.001).