Key result
Receiving at least 2 classes of guideline-recommended medications at ≥50% target dose was associated with the lowest 1-year mortality, despite suboptimal prescription rates (e.g., 62% for ACEI/ARB).
Why the study?
Does adherence to guideline-recommended medications improve 1-year mortality in patients hospitalized for acute HFrEF?
Observational (n=1,509)
Yes
Does adherence to guideline-recommended medications improve 1-year mortality in patients hospitalized for acute HFrEF?
Real-world registry data from Taiwan highlights significant under-prescription and under-dosing of guideline-directed medical therapy for HFrEF, which is associated with worse 1-year mortality.
May encourage GDMT optimization in acute HFrEF; leaves open whether higher adherence causally improves survival.
BACKGROUND: Heart failure (HF) is a global health problem. Guidelines for the management of HF have been established in Western countries and in Taiwan. However, data from the Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed suboptimal prescription of guideline-recommended medications. We aimed to analyze the reason of non-prescription and clinical outcomes as a result of under-prescription of medications. METHODS: A total of 1509 patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan by the end of October 2014. Prescribed guideline-recommended medications and other relevant clinical parameters were collected and analyzed at discharge and 1 year after index hospitalization. RESULTS: At discharge, 62% of patients were prescribed with either angiotensin-converting enzyme-inhibitors (ACEI) or angiotensin receptor blockers (ARB); 60% were prescribed with beta-blockers and 49% were prescribed with mineralocorticoid receptor antagonists (MRA). The proportions of patients at ≥50% of the target dose for ACEI/ARB, beta-blockers and MRA were 24.4%, 20.6%, 86.2%, respectively. At 1-year follow-up, dosages of ACEI/ARB and MRA were up-titrated in about one-fourth patients, and dosages of beta-blocker were up-titrated in about 40% patients. One-year mortality rate was lowest in patients who received at least 2 classes of guideline-recommended medications with ≥50% of the target dose, and highest in those who received 0 or 1 class of medications. CONCLUSION: The TSOC-HFrEF registry demonstrated the under-prescription of guideline-recommended medications and reluctance of physicians to up-titrate medications to target dose. Action plan needs be formulated in order to improve physician's adherence to HF guidelines.
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Chang et al. (2017) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=1,509). Guideline-recommended medications (ACEI/ARB, beta-blockers, MRA) vs. 0 or 1 class of medications was evaluated on One-year mortality rate. Receiving at least 2 classes of guideline-recommended medications at ≥50% target dose was associated with the lowest 1-year mortality, despite suboptimal prescription rates (e.g., 62% for ACEI/ARB).
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