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PIIS0953620521002636.pdf (3.63 MB)

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2021-08-01

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cc by (c) Tost, Josep et al., 2021
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/182765

Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation

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Recurs relacionat

https://doi.org/10.1016/j.ejim.2021.07.013

Resum

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.

Matèries

Insuficiència cardíaca, Pronòstic mèdic

Matèries (anglès)

Heart failure, Prognosis, Emergency medical services, Serveis d'urgències mèdiques

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Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

Citació

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. Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation. _European Journal of Internal Medicine_. 2021. Vol.  vol 94, núm. 73-84. [consulta: 21 de gener de 2026]. [Disponible a: https://hdl.handle.net/2445/182765]

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