Portal de investigação
Association between a hospitalization for heart failure and the initiation/discontinuation of guideline-recommended treatments: an analysis from the Swedish Heart Failure Registry
Data de publicação:
Data Ahead of Print:
Autores da FMUP
Participantes de fora da FMUP
- Schrage, B
- Lund, LH
- Benson, L
- Braunschweig, F
- Dahlström, U
- Metra, M
- Rosano, GMC
- Savarese, G
Unidades de investigação
Abstract
Aims To investigate whether a heart failure (HF) hospitalization is associated with initiation/discontinuation of guideline-directed medical HF therapy (GDMT) and consequent outcomes.Methods and results Among patients in the Swedish HF registry with an ejection fraction <50% enrolled in 2009-2018, initiation/discontinuation of GDMT was investigated by assessing dispensations of GDMT in those with versus without a HF hospitalization. Of 14 737 patients, 6893 (47%) were enrolled when hospitalized for HF. Initiation of GDMT was more likely than discontinuation following a HF hospitalization compared to a control group of patients without a HF hospitalization (odds ratio range 2.1-4.0 vs. 1.4-1.6 for the individual medications), although the proportion of patients not on GDMT was still high (8.1-44.0%). Key patient characteristics triggering less use of GDMT (i.e. less initiation or more discontinuation) were older age and worse renal function. Following a HF hospitalization, initiation of renin-angiotensin system inhibitors/angiotensin receptor-neprilysin inhibitors or beta-blockers was associated with lower and their discontinuation with higher mortality risk, but no association with mortality was observed for initiation/discontinuation of mineralocorticoid receptor antagonists.Conclusions Following a HF hospitalization, initiation of GDMT was more likely than discontinuation, although still limited. Perceived or actual low tolerance were barriers to GDMT implementation. Early re-/initiation of GDMT was associated with better survival. Our findings represent a call for further implementing the current guideline recommendation for an early re-/initiation of GDMT following a HF hospitalization.
Dados da publicação
- ISSN/ISSNe:
- 1388-9842, 1879-0844
- Tipo:
- Article
- Páginas:
- 1132-1144
- DOI:
- 10.1002/ejhf.2928
- Link para outro recurso:
- www.scopus.com
European Journal of Heart Failure Wiley-Blackwell
Citações Recebidas na Web of Science: 1
Citações Recebidas na Scopus: 12
Documentos
- Não há documentos
Filiações
Keywords
- Heart failure with reduced ejection fraction; Heart failure with mildly reduced ejection fraction; Guideline-directed medical therapy; Initiation; Discontinuation; Guidelines; Implementation
Proyectos asociados
Dapagliflozin, Spironolactone or Both for HFpEF (SOGALDI-PEF) - NCT05676684
Investigador Principal: João Pedro Melo Marques Pinho Ferreira
Ensaio Clínico Académico (SOGALDI-PEF) . AstraZeneca . 2022
Citar a publicação
Schrage B,Lund LH,Benson L,Braunschweig F,Ferreira JP,Dahlström U,Metra M,Rosano GMC,Savarese G. Association between a hospitalization for heart failure and the initiation/discontinuation of guideline-recommended treatments: an analysis from the Swedish Heart Failure Registry. Eur. J. Heart Fail. 2023. 25. (7):p. 1132-1144. IF:18,200. (1).
