Key result
Carvedilol linked to ~33% higher heart failure readmission risk versus β1-selective beta-blockers.
Why the study?
The study evaluated the association between HF medication at discharge and HF readmissions in a real-world unselected population after a first HF hospital admission, including specific comparisons among drug classes and effects relative to time since discharge.
Does heart failure medication at discharge reduce heart failure readmission in patients after a first hospital admission for HF?
Cohort (n=22,476)
Yes
Does heart failure medication at discharge reduce heart failure readmission in patients after a first hospital admission for HF?
Effect estimate: HR 1.01 (95% CI 0.96-1.06)
In a real-world cohort, standard HF medications did not show long-term readmission benefits overall likely due to confounding by indication, though protective effects were seen shortly after discharge and carvedilol was associated with higher readmission risk than beta-1 selective beta-blockers.
No overall readmission benefit from ACEI/ARB or beta-blockers post-HF admission; leaves open whether carvedilol increases risk versus selective agents.
BACKGROUND: This study assessed the association between heart failure (HF) medication (angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB), beta-blockers (BB), mineralocorticoid-receptor antagonists (MRA) and diuretics) and HF readmissions in a real-world unselected group of patients after a first hospital admission for HF. Furthermore we analysed readmission rates for ACEI versus ARB and for carvedilol versus β1-selective BB and we investigated the effect of HF medication in relation to time since discharge. METHODS AND FINDINGS: Medication at discharge was determined with dispensing data from the Dutch PHARMO Database Network including 22,476 patients with HF between 2001 and 2015. After adjustment for age, gender, number of medications and year of admission no associations were found for users versus non-users of ACEI/ARB (hazard ratio, HR = 1.01; 95%CI 0.96-1.06), BB (HR = 1.00; 95%CI 0.95-1.05) and readmissions. The risk of readmission for patients prescribed MRA (HR = 1.11; 95%CI 1.05-1.16) or diuretics (HR = 1.17; 95%CI 1.09-1.25) was higher than for non-users. The HR for ARB relative to ACEI was 1.04 (95%CI 0.97-1.12) and for carvedilol relative to β1-selective BB 1.33 (95%CI 1.20-1.46). Post-hoc analyses showed a protective effect shortly after discharge for most medications. For example one month post discharge the HR for ACEI/ARB was 0.77 (95%CI 0.69-0.86). Although we did try to adjust for confounding by indication, probably residual confounding is still present. CONCLUSIONS: Patients who were prescribed carvedilol have a higher or at least a similar risk of HF readmission compared to β1-selective BB. This study showed that all groups of HF medication -some more pronounced than others- were more effective immediately following discharge.
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Kruik‐Kollöffel et al. (2020) conducted a cohort in Heart failure (n=22,476). Heart failure medications (ACEI/ARB, beta-blockers, MRA, diuretics) vs. Non-users or alternative within-class medications was evaluated on Heart failure readmission (HR 1.01, 95% CI 0.96-1.06). Carvedilol was associated with a higher risk of heart failure readmission compared to β1-selective beta-blockers (HR 1.33; 95% CI 1.20-1.46), while ACEI/ARB and BB showed no overall association.
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