Heart failure oral therapies at discharge are associated with better outcome in acute heart failure : a propensity-score matched study
© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology..
AIMS: Heart failure oral therapies (HFOTs), including beta-blockers (BB), renin-angiotensin system inhibitors (RASi) and mineralocorticoid receptor antagonists, administered before hospital discharge after acute heart failure (AHF) might improve outcome. However, concerns have been raised because early administration of HFOTs may worsen patient's condition. We hypothesized that HFOTs at hospital discharge might be associated with better post-discharge survival.
METHODS AND RESULTS: The study population was composed of 19 980 AHF patients from the GREAT registry. The primary and secondary outcomes were 90-day and 1-year all-cause mortality, respectively. Survival was estimated with univariate and covariate-adjusted Cox proportional hazards regression models for the whole population and after propensity-score matching. HFOTs at discharge were consistently associated with no excess mortality in the unadjusted and adjusted analyses of the whole and matched cohorts. In the matched cohort, BB and RASi at discharge were associated with lower 90-day mortality risks compared to the respective untreated groups [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.46-0.69; and HR 0.53, 95% CI 0.42-0.66, respectively]. The favourable associations of BB and RASi at discharge with 90-day mortality were present in many subgroups including patients with reduced or preserved left ventricular ejection fraction and persisted up to 1 year after discharge. The combination of RASi and BB was associated with an even lower risk of death than RASi or BB alone.
CONCLUSIONS: Administration of HFOTs at hospital discharge is associated with better survival of AHF patients.
| Errataetall: |
CommentIn: Eur J Heart Fail. 2018 Feb;20(2):355-358. - PMID 29027354 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:20 |
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| Enthalten in: |
European journal of heart failure - 20(2018), 2 vom: 16. Feb., Seite 345-354 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gayat, Etienne [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 11.12.2018 Date Revised 11.12.2018 published: Print-Electronic CommentIn: Eur J Heart Fail. 2018 Feb;20(2):355-358. - PMID 29027354 Citation Status MEDLINE |
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| doi: |
10.1002/ejhf.932 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM275221423 |
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| 100 | 1 | |a Gayat, Etienne |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Heart failure oral therapies at discharge are associated with better outcome in acute heart failure |b a propensity-score matched study |
| 264 | 1 | |c 2018 | |
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| 500 | |a Date Revised 11.12.2018 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Eur J Heart Fail. 2018 Feb;20(2):355-358. - PMID 29027354 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology. | ||
| 520 | |a AIMS: Heart failure oral therapies (HFOTs), including beta-blockers (BB), renin-angiotensin system inhibitors (RASi) and mineralocorticoid receptor antagonists, administered before hospital discharge after acute heart failure (AHF) might improve outcome. However, concerns have been raised because early administration of HFOTs may worsen patient's condition. We hypothesized that HFOTs at hospital discharge might be associated with better post-discharge survival | ||
| 520 | |a METHODS AND RESULTS: The study population was composed of 19 980 AHF patients from the GREAT registry. The primary and secondary outcomes were 90-day and 1-year all-cause mortality, respectively. Survival was estimated with univariate and covariate-adjusted Cox proportional hazards regression models for the whole population and after propensity-score matching. HFOTs at discharge were consistently associated with no excess mortality in the unadjusted and adjusted analyses of the whole and matched cohorts. In the matched cohort, BB and RASi at discharge were associated with lower 90-day mortality risks compared to the respective untreated groups [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.46-0.69; and HR 0.53, 95% CI 0.42-0.66, respectively]. The favourable associations of BB and RASi at discharge with 90-day mortality were present in many subgroups including patients with reduced or preserved left ventricular ejection fraction and persisted up to 1 year after discharge. The combination of RASi and BB was associated with an even lower risk of death than RASi or BB alone | ||
| 520 | |a CONCLUSIONS: Administration of HFOTs at hospital discharge is associated with better survival of AHF patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Acute heart failure | |
| 650 | 4 | |a Oral therapy | |
| 650 | 4 | |a Prognosis | |
| 650 | 7 | |a Angiotensin Receptor Antagonists |2 NLM | |
| 650 | 7 | |a Angiotensin-Converting Enzyme Inhibitors |2 NLM | |
| 650 | 7 | |a Mineralocorticoid Receptor Antagonists |2 NLM | |
| 700 | 1 | |a Arrigo, Mattia |e verfasserin |4 aut | |
| 700 | 1 | |a Littnerova, Simona |e verfasserin |4 aut | |
| 700 | 1 | |a Sato, Naoki |e verfasserin |4 aut | |
| 700 | 1 | |a Parenica, Jiri |e verfasserin |4 aut | |
| 700 | 1 | |a Ishihara, Shiro |e verfasserin |4 aut | |
| 700 | 1 | |a Spinar, Jindrich |e verfasserin |4 aut | |
| 700 | 1 | |a Müller, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Harjola, Veli-Pekka |e verfasserin |4 aut | |
| 700 | 1 | |a Lassus, Johan |e verfasserin |4 aut | |
| 700 | 1 | |a Miró, Òscar |e verfasserin |4 aut | |
| 700 | 1 | |a Maggioni, Aldo P |e verfasserin |4 aut | |
| 700 | 1 | |a AlHabib, Khalid F |e verfasserin |4 aut | |
| 700 | 1 | |a Choi, Dong-Ju |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Jin Joo |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Yuhui |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Jian |e verfasserin |4 aut | |
| 700 | 1 | |a Januzzi, James L |c Jr |e verfasserin |4 aut | |
| 700 | 1 | |a Kajimoto, Katsuya |e verfasserin |4 aut | |
| 700 | 1 | |a Cohen-Solal, Alain |e verfasserin |4 aut | |
| 700 | 1 | |a Mebazaa, Alexandre |e verfasserin |4 aut | |
| 700 | 0 | |a GREAT Network |e verfasserin |4 aut | |
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