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Title: Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
Author: Tost, Josep
Llorens, Pere
Cotter, Gad
Davison, Beth
Jacob, Javier
Gil Espinosa, Victor
Herrero, Pablo
Martín Sánchez, Francisco Javier
Donea, Ruxandra
Rodríguez Salgado, Beatriz
Lucas Imbernon, Francisco Javier
Andueza, Juan Antonio
Mecina, Ana Belén
Torres Gárate, Raquel
Piñera, Pascual
Alquézar Arbé, Aitor
Espinosa, Begoña
Mebazaa, Alexandre
Chioncel, Ovidiu
Miró, Òscar
Keywords: Insuficiència cardíaca
Pronòstic mèdic
Heart failure
Emergency medical services
Serveis d'urgències mèdiques
Issue Date: 1-Aug-2021
Publisher: Elsevier BV
Abstract: Aims: To analyze the frequency with which patients with heart failure with preserved ejection fraction (HFpEF) discharged after an acute heart failure (AHF) episode are treated with antineurohormonal drugs (ANHD), the variables related to ANHD prescription and their relationship with outcomes. Methods: We included consecutive HFpEF patients (left ventricular ejection fraction >= 50%) discharged after an AHF episode from 45 Spanish hospitals whose chronic medications and treatment at discharge were available. Patients were classified according to whether they were discharged with or without ANHD, including beta-blockers (BB), renin-angiotensin-aldosterone-system inhibitors (RAASi) and mineralcorticosteroid-receptor antagonists (MRA). Co-primary outcomes consisted of 1-year all-cause mortality and 90-day combined adverse event (revisit to emergency department -ED-, hospitalization due to AHF or all-cause death). Secondary outcomes were 90-day adverse events taken individually. Adjusted associations of ANHD treatment with outcomes were calculated. Results: We analyzed 3,305 patients with HFpEF (median age: 83, 60% women), 2,312 (70%) discharged with ANHD. The ANHD most frequently prescribed was BB (45.8%). The 1-year mortality was 26.9% (adjusted HR for ANHD patients:1.17, 95%CI=0.98-1.38) and the 90-day combined adverse event was 54.4% (HR=1.14, 95% CI=0.99-1.31). ED revisit was significantly increased by ANHD (HR=1.15, 95%CI=1.01-1.32). MRA and BB were associated with worse results in some co-primary or secondary endpoints, while RAASi (alone) reduced 90-day hospitalization (HR=0.73, 98%CI=0.56-0.96). Conclusion: 70% of HFpEF patients are discharged with ANHD after an AHF episode. ANHD do not seem to reduce mortality or adverse events in HFpEF patients, only RAASi could provide some benefits, reducing the risk of hospitalization for AHF.
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It is part of: European Journal of Internal Medicine, 2021, vol 94, p. 73-84
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Appears in Collections:Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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