What question did this study set out to answer?

To evaluate global temporal trends in 30-day and 1-year all-cause mortality and readmission rates following acute heart failure over four decades and determine the impact of oral cardiovascular medications.

January 15, 2021European Journal of Heart Failure

Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta‐regression in the past four decades

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Why the study?

Temporal trends and the benefits of long-term oral cardiovascular medications on acute heart failure outcomes remained uncertain.

Have mortality and readmission rates after acute heart failure improved over the past four decades, and are these trends associated with the use of oral cardiovascular therapies?

Population

15 million AHFs across 285 studies

Comparison

Temporal trends and proportions of oral cardiovascular therapies

Design

Systematic review and meta-regression

Follow-up

30-day and 1-year

Authors

AKAntoine KimmounGoogle (United States)KTKoji TakagiHeart Failure / Cardiomyopathy EGEmmanuel GallInserm

Discussion

Member takes

Implication

May support wider RAASi plus beta-blocker use after AHF; extends observational survival associations but leaves readmission impact and causality open.

Key Points

To evaluate global temporal trends in 30-day and 1-year all-cause mortality and readmission rates following acute heart failure over four decades and determine the impact of oral cardiovascular medications.
Systematic review and meta-regression registered in PROSPERO (CRD42018099885) analyzing studies published between 1980 and 2017 with >100 patients.
Screened 45,143 studies and included 285 studies encompassing 15 million acute heart failure episodes globally.
Significant 10-year incremental declines occurred for 30-day all-cause mortality (OR 0.74, 95% CI 0.61–0.91; P = 0.004) and 1-year all-cause mortality (OR 0.86, 95% CI 0.77–0.96; P = 0.007).
Rates of 30-day and 1-year all-cause hospital readmission remained largely unchanged across the four-decade period.
The decline in 1-year mortality correlated with higher prescription of oral beta-blockers combined with renin-angiotensin-aldosterone system inhibitors, while diuretics showed no association with improved survival.

Structured PICO

Have mortality and readmission rates after acute heart failure improved over the past four decades, and are these trends associated with the use of oral cardiovascular therapies?

Population

15 million acute heart failure (AHF) patients from 285 studies published between 1980 and 2017 (inclusion criteria: AHF studies with >100 patients reporting death and/or readmission).

Intervention

Temporal progression (10-year increments) and use of oral cardiovascular therapies (beta-blockers, renin-angiotensin-aldosterone system inhibitors).

Comparator

Earlier time periods and lower proportions of oral cardiovascular therapies.

Outcome

Temporal trends for 30-day or 1-year all-cause death and/or readmission rates.hard clinical

Survival after acute heart failure has improved globally over the past four decades, likely associated with increased use of oral neurohormonal antagonists, though readmission rates remain unchanged.

Cite This Study

Kimmoun et al. (2021) studied this question.

synapsesocial.com/papers/6a7fea0b7f27fdae4f502b19 https://doi.org/10.1002/ejhf.2103

Topics

Heart failure HFrEF treatment Heart failure hospitalization HFpEF management

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Implication

May support wider RAASi plus beta-blocker use after AHF; extends observational survival associations but leaves readmission impact and causality open.

Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta‐regression in the past four decades

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta‐regression in the past four decades

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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