Why the study?
Does guideline-directed medical therapy reduce re-hospitalization and mortality in patients with acute heart failure and reduced ejection fraction?
Cohort (n=2,769)
Yes
Does guideline-directed medical therapy reduce re-hospitalization and mortality in patients with acute heart failure and reduced ejection fraction?
Hazard Ratio: 0.52 (95% CI 0.36–0.77)
p-value: p=<0.001
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.
GDMT at discharge may improve short-term outcomes more in de novo AHF; leaves open causal effects beyond this registry cohort.
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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Ahn et al. (2019) conducted a cohort in Acute heart failure with reduced ejection fraction (n=2,769). Guideline-directed therapy (ACEI/ARB) vs. Non-adherence to guideline-directed therapy was evaluated on 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).
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