What is the clinical evidence from this study?

Study design: Cohort. Population: Acute heart failure with reduced ejection fraction (n=2769). Intervention: Guideline-directed therapy (ACEI/ARB) vs. Non-adherence to guideline-directed therapy. Primary outcome: 60-day composite endpoint of mortality or heart failure hospitalization in de novo acute heart failure (HR 0.52, 95% CI 0.36-0.77, p=<0.001).

January 1, 2019Open Access

Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure

Q: What are the key findings of this study?

Adherence to ACEI or ARB therapy at discharge reduced the 60-day composite risk of mortality or heart failure hospitalization by 48% (HR 0.52) in patients with de novo acute heart failure.

Resultado clave

Adherence to ACEI or ARB therapy at discharge reduced the 60-day composite risk of mortality or heart failure hospitalization by 48% (HR 0.52) in patients with de novo acute heart failure.

Diseño del estudio

Tipo

Cohort (n=2,769)

Multicéntrico

Sí

PICO estructurado

Does guideline-directed medical therapy reduce re-hospitalization and mortality in patients with acute heart failure and reduced ejection fraction?

Población

2,769 patients with acute heart failure and reduced ejection fraction (LVEF < 40%) were followed for 60 days to assess the prognostic impact of guideline-directed medical therapy at discharge.

Exposición

Guideline-directed medical therapy, defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), beta-blocker, and mineralocorticoid receptor antagonist.

Resultado

Re-hospitalization, mortality, and a composite endpointhard clinical

Guideline-directed medical therapy (ACEI/ARB and beta-blockers) significantly reduces mortality and re-hospitalization in acute heart failure with reduced ejection fraction, with benefits being most noticeable when started early in the disease course.

Resultado numérico

Hazard Ratio: 0.52 (95% CI 0.36–0.77)

valor p: p=<0.001

Limitaciones

Treatment options were entirely dependent on the attending physician, introducing potential selection bias.
Risk-treatment mismatch was present, as high-risk patients had lower rates of guideline-directed therapy.
The influence of background therapy and specific doses of guideline-directed therapy were not analyzed.
Drug adherence during the follow-up period was not considered.

Resumen

BACKGROUND: acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. METHODS: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. RESULTS: AHF, ACEI or ARB reduced re-hospitalization (hazard ratio HR, 0.57; 95% confidence interval CI, 0.34-0.95), mortality (HR, 0.41; 95% CI, 0.24-0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36-0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41-0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47-0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. CONCLUSION: heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.

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