What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure with midrange ejection fraction (HFmrEF) (n=1144). Intervention: β-blocker therapy on discharge vs. No β-blocker therapy. Primary outcome: all-cause mortality (HR 0.758, 95% CI 0.615-0.934, p=0.009).

What question did this study set out to answer?

To assess the relationship between guideline-directed medical therapies—including β-blockers, renin-angiotensin system blockers, and aldosterone antagonists—and clinical outcomes in patients with heart failure with midrange ejection fraction.

October 25, 2018Journal of the American Heart AssociationOpen Access

Guideline‐Directed Medical Therapy for Patients With Heart Failure With Midrange Ejection Fraction: A Patient‐Pooled Analysis From the KorHF and KorAHF Registries

View Full Paper

Ask AI

Bookmark

Key result

Discharge use of β-blockers (HR 0.758, P=0.009) and RASB (HR 0.76, P=0.013) were associated with reduced all-cause mortality in patients with acute HFmrEF, whereas aldosterone antagonists were not.

Why the study?

Does guideline-directed medical therapy (beta-blocker, RASB, or AA) reduce all-cause mortality in patients with HFmrEF hospitalized for acute heart failure?

Population

1,144 patients with heart failure with midrange ejection fraction hospitalized for acute heart failure, from…

Comparison

Guideline-directed medical therapy on discharge vs No use of the respective medication on discharge

Design

Cohort

Authors

KCKi Hong ChoiInterventional Cardiology JCJin‐Oh ChoiHeart Failure & Transplant EJEun‐Seok JeonKurume University

Discussion

Member takes

Implication

May support beta-blocker and RASB use at discharge in acute HFmrEF; hypothesis-generating and requires RCT confirmation before practice change.

Key Points

To assess the relationship between guideline-directed medical therapies—including β-blockers, renin-angiotensin system blockers, and aldosterone antagonists—and clinical outcomes in patients with heart failure with midrange ejection fraction.
Analyzed pooled patient-level data from 1,144 patients hospitalized for acute heart failure with midrange ejection fraction (left ventricular ejection fraction 40% to 49%) enrolled across the KorHF and KorAHF registries (NCT01389843).
Compared outcomes based on discharge prescriptions of β-blockers, renin-angiotensin system blockers (RASBs), and aldosterone antagonists (AAs).
Conducted sensitivity analyses utilizing propensity score matching and inverse-probability-weighted methods to adjust for baseline differences.
β-blocker therapy at discharge significantly reduced all-cause mortality compared with non-use (30.7% vs. 38.2%; HR 0.758; 95% CI, 0.615–0.934; P=0.009).
RASB prescription at discharge was associated with a significant reduction in all-cause mortality compared with non-use (31.9% vs. 38.1%; HR 0.760; 95% CI, 0.618–0.946; P=0.013).
Aldosterone antagonist use demonstrated no significant reduction in all-cause mortality compared with non-use (34.2% vs. 34.0%; HR 1.063; 95% CI, 0.858–1.317; P=0.578).

Study Design

Type

Observational (n=1,144)

Multicenter

Yes

Structured PICO

Does guideline-directed medical therapy (beta-blocker, RASB, or AA) reduce all-cause mortality in patients with HFmrEF hospitalized for acute heart failure?

Population

1,144 patients with heart failure with midrange ejection fraction (LVEF 40-49%) hospitalized for acute heart failure, analyzed from two Korean registries.

Exposure

Guideline-directed medical therapy on discharge (specifically beta-blocker, renin-angiotensin system blocker [RASB], or aldosterone antagonist [AA])

Comparator

No use of the respective medication (no beta-blocker, no RASB, or no AA) on discharge

Outcome

All-cause mortalityhard clinical

Main Result

Hazard Ratio: 0.758 (95% CI 0.615–0.934)

Absolute Event Rate: 30.7% vs 38.2%

p-value: p=0.009

Beta-blockers and renin-angiotensin system blockers prescribed at discharge are associated with reduced all-cause mortality in patients hospitalized for acute heart failure with mid-range ejection fraction.

Cite This Study

Choi et al. (2018) conducted an observational in Heart failure with midrange ejection fraction (HFmrEF) (n=1,144). β-blocker therapy on discharge vs. No β-blocker therapy was evaluated on all-cause mortality (HR 0.758, 95% CI 0.615-0.934, p=0.009). Discharge use of β-blockers (HR 0.758, P=0.009) and RASB (HR 0.76, P=0.013) were associated with reduced all-cause mortality in patients with acute HFmrEF, whereas aldosterone antagonists were not.

synapsesocial.com/papers/6a9639df0f79e4f014b2db1a https://doi.org/10.1161/jaha.118.009806

Topics

Heart failure HFrEF treatment HFpEF management Heart failure hospitalization

View Full Paper

Ask AI

Bookmark

Implication

May support beta-blocker and RASB use at discharge in acute HFmrEF; hypothesis-generating and requires RCT confirmation before practice change.

Guideline‐Directed Medical Therapy for Patients With Heart Failure With Midrange Ejection Fraction: A Patient‐Pooled Analysis From the KorHF and KorAHF Registries

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Guideline‐Directed Medical Therapy for Patients With Heart Failure With Midrange Ejection Fraction: A Patient‐Pooled Analysis From the KorHF and KorAHF Registries

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider