The independent reduction in mortality associated with guideline-directed medical therapy in patients with coronary artery disease and heart failure with reduced ejection fraction
Key result
Guideline-directed medical therapy was independently associated with a significant reduction in all-cause mortality (HR 0.65; 95% CI 0.56-0.76; P<0.001) in patients with CAD and HFrEF.
Why the study?
GDMT is underutilized in CAD, and no studies had evaluated the impact of GDMT adherence on mortality in patients with both CAD and HFrEF.
Does adherence to guideline-directed medical therapy reduce all-cause mortality in patients with coronary artery disease and HFrEF?
Comparison
GDMT adherence vs non-adherence
Design
Post hoc analysis of a randomized trial using multivariable Cox regression
Follow-up
Median 9.8 years
Authors
Discussion
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Implication
GDMT adherence may lower mortality in CAD-HFrEF; leaves open prospective trials on adherence strategies.
Study Design
Type
RCT (n=1,212)
Randomization
randomized
Structured PICO
Does adherence to guideline-directed medical therapy reduce all-cause mortality in patients with coronary artery disease and HFrEF?
P
Population
1,212 patients with CAD amenable to CABG and LVEF ≤35%, followed for a median of 9.8 years.
I
Intervention
Adherence to guideline-directed medical therapy (GDMT), defined as the combination of at least one antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB).
C
Comparator
Non-adherence to guideline-directed medical therapy.
O
Outcome
All-cause mortalityhard clinical
Main Result
Hazard Ratio: 0.65 (95% CI 0.56–0.76)
p-value: p=< 0.001
Adherence to guideline-directed medical therapy is associated with a significant reduction in long-term mortality in patients with CAD and HFrEF, independent of surgical revascularization.
Cite This Study
Wolfe et al. (2020) conducted an RCT in Coronary artery disease and heart failure with reduced ejection fraction (n=1,212). Guideline-directed medical therapy (GDMT) vs. Non-adherence to GDMT was evaluated on all-cause mortality (HR 0.65, 95% CI 0.56-0.76, p=< 0.001). Guideline-directed medical therapy was independently associated with a significant reduction in all-cause mortality (HR 0.65; 95% CI 0.56-0.76; P<0.001) in patients with CAD and HFrEF.