Maintaining RAS inhibitors (HR 0.50; 95% CI 0.31-0.81) and beta-blockers (HR 0.48; 95% CI 0.28-0.81) was associated with a lower incidence of HF relapse in AiCM with improved LVEF.
Cohort (n=200)
No
Does maintaining guideline-directed medical therapy (RAS inhibitors and beta-blockers) prevent heart failure relapse in patients with arrhythmia-induced cardiomyopathy following LVEF improvement?
In patients with arrhythmia-induced cardiomyopathy who have experienced LVEF improvement, continuing RAS inhibitors and beta-blockers significantly reduces the risk of heart failure relapse.
Effect estimate: HR 0.50 (RAS inhibitors), HR 0.48 (beta-blockers) (95% CI 0.31-0.81 (RAS inhibitors), 0.28-0.81 (beta-blockers))
p-value: p=0.005 (RAS inhibitors), 0.006 (beta-blockers)
AIMS: No study has analyzed the impact of guideline-directed medical therapy in preventing heart failure (HF) relapse in patients with arrhythmia-induced cardiomyopathy (AiCM) following left ventricular ejection fraction (LVEF) improvement. METHODS AND RESULTS: We analyzed data from a single-center cohort of 200 patients admitted for HF, LVEF <50% and cardiac arrhythmia considered by cardiologists to be the precipitating cause of the episode. The primary endpoint was time-to-HF relapse, defined as the composite of readmission for HF, Emergency Department (ED) visit for HF, or significant decline in LVEF. Changes in medication were recorded and a time-varying multivariate Cox regression was performed. After a median follow-up period of 6.14 years, diagnostic confirmation was achieved in 188 out of the initial 200 patients with suspected AiCM. A total of 89 patients (47.3%) met the primary endpoint. RAS inhibitors (adjusted hazard ratio (HR) 0.50 0.31-0.81; p = 0.005) and beta-blockers (adjusted HR 0.48 0.28-0.81; p = 0.006) were associated with a lower incidence of relapse. Mineralocorticoid receptor antagonists were associated with a significantly lower incidence of ED visits for HF (adjusted HR 0.38 0.15-0.95; p = 0.038), but did not achieve statistical significance for the combined primary endpoint. Antiarrhythmic drugs did not show a significant impact on the primary endpoint. CONCLUSION: Maintaining RAS inhibitors and beta-blockers was associated with a significantly lower incidence of relapse in the setting of AiCM with improved LVEF.
Domínguez‐Rodríguez et al. (Wed,) conducted a cohort in Arrhythmia-induced cardiomyopathy (AiCM) with improved LVEF (n=200). Guideline-directed medical therapy (RAS inhibitors and beta-blockers) was evaluated on Time-to-HF relapse (composite of readmission for HF, ED visit for HF, or significant decline in LVEF) (HR 0.50 (RAS inhibitors), HR 0.48 (beta-blockers), 95% CI 0.31-0.81 (RAS inhibitors), 0.28-0.81 (beta-blockers), p=0.005 (RAS inhibitors), 0.006 (beta-blockers)). Maintaining RAS inhibitors (HR 0.50; 95% CI 0.31-0.81) and beta-blockers (HR 0.48; 95% CI 0.28-0.81) was associated with a lower incidence of HF relapse in AiCM with improved LVEF.
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