Intensity of Guideline-Directed Medical Therapy for Coronary Heart Disease and Ischemic Heart Failure Outcomes
Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved..
PURPOSE: The impact of guideline-directed medical therapy for coronary heart disease in those hospitalized with acute heart failure is unknown.
METHODS: We studied guideline-directed medical therapies for coronary disease: angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta-adrenoreceptor antagonists, antiplatelet agents or anticoagulants, and statins. Using inverse probability of treatment weighting the propensity score, we examined associations of guideline-directed medical therapy intensity (categorized as low [0-1], high [2-3], or very high [4] number of drugs) with mortality in 1873 patients with angina, troponin elevation, or prior myocardial infarction.
RESULTS: At discharge, 0-1, 2-3, and 4 medications were prescribed in 467 (25%), 705 (38%), and 701 (37%) patients, respectively. Relative to those prescribed 0-1 drugs (reference), all-cause mortality was lower with 2-3 (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.28-0.84, P = 0.009) or all 4 drug classes (HR 0.56, 95% CI 0.33-0.96, P = 0.034) over 181-365 days, with similar reductions present from 0-180 days. In those with heart failure with preserved ejection fraction, mortality trended lower with 2-3 drug classes (HR 0.43, 95% CI 0.18-1.02, P = 0.054) and was significantly reduced with 4 drugs (HR 0.32, 95%CI 0.12-0.84, P = 0.021) during 0-180 day follow-up. In heart failure with reduced ejection fraction, all-cause mortality was reduced during both 0-180 and 181-365 days when discharged on 2-3 (HR 0.30 for 181-365 days, 95%CI 0.14-0.64, P = 0.002) or all 4 drug classes (HR 0.43, 95%CI 0.19-0.95, P = 0.038).
CONCLUSIONS: Increasing guideline-directed medical therapy intensity for coronary heart disease resulted in lower mortality in patients with acute ischemic heart failure with both preserved and reduced ejection fractions.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:134 |
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| Enthalten in: |
The American journal of medicine - 134(2021), 5 vom: 01. Mai, Seite 672-681.e4 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Crosier, Rebecca [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 22.06.2021 Date Revised 22.06.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.amjmed.2020.10.017 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM317486209 |
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| 100 | 1 | |a Crosier, Rebecca |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Intensity of Guideline-Directed Medical Therapy for Coronary Heart Disease and Ischemic Heart Failure Outcomes |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 22.06.2021 | ||
| 500 | |a Date Revised 22.06.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: The impact of guideline-directed medical therapy for coronary heart disease in those hospitalized with acute heart failure is unknown | ||
| 520 | |a METHODS: We studied guideline-directed medical therapies for coronary disease: angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta-adrenoreceptor antagonists, antiplatelet agents or anticoagulants, and statins. Using inverse probability of treatment weighting the propensity score, we examined associations of guideline-directed medical therapy intensity (categorized as low [0-1], high [2-3], or very high [4] number of drugs) with mortality in 1873 patients with angina, troponin elevation, or prior myocardial infarction | ||
| 520 | |a RESULTS: At discharge, 0-1, 2-3, and 4 medications were prescribed in 467 (25%), 705 (38%), and 701 (37%) patients, respectively. Relative to those prescribed 0-1 drugs (reference), all-cause mortality was lower with 2-3 (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.28-0.84, P = 0.009) or all 4 drug classes (HR 0.56, 95% CI 0.33-0.96, P = 0.034) over 181-365 days, with similar reductions present from 0-180 days. In those with heart failure with preserved ejection fraction, mortality trended lower with 2-3 drug classes (HR 0.43, 95% CI 0.18-1.02, P = 0.054) and was significantly reduced with 4 drugs (HR 0.32, 95%CI 0.12-0.84, P = 0.021) during 0-180 day follow-up. In heart failure with reduced ejection fraction, all-cause mortality was reduced during both 0-180 and 181-365 days when discharged on 2-3 (HR 0.30 for 181-365 days, 95%CI 0.14-0.64, P = 0.002) or all 4 drug classes (HR 0.43, 95%CI 0.19-0.95, P = 0.038) | ||
| 520 | |a CONCLUSIONS: Increasing guideline-directed medical therapy intensity for coronary heart disease resulted in lower mortality in patients with acute ischemic heart failure with both preserved and reduced ejection fractions | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Cardiovascular | |
| 650 | 4 | |a Coronary artery disease | |
| 650 | 4 | |a Coronary heart disease | |
| 650 | 4 | |a Drug therapy | |
| 650 | 4 | |a Guideline-directed medical treatment | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Hospitalizations | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Outcomes | |
| 650 | 4 | |a Practice guidelines | |
| 650 | 7 | |a Adrenergic beta-Antagonists |2 NLM | |
| 650 | 7 | |a Angiotensin Receptor Antagonists |2 NLM | |
| 650 | 7 | |a Angiotensin-Converting Enzyme Inhibitors |2 NLM | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 650 | 7 | |a Hydroxymethylglutaryl-CoA Reductase Inhibitors |2 NLM | |
| 650 | 7 | |a Platelet Aggregation Inhibitors |2 NLM | |
| 700 | 1 | |a Austin, Peter C |e verfasserin |4 aut | |
| 700 | 1 | |a Ko, Dennis T |e verfasserin |4 aut | |
| 700 | 1 | |a Lawler, Patrick R |e verfasserin |4 aut | |
| 700 | 1 | |a Stukel, Therese A |e verfasserin |4 aut | |
| 700 | 1 | |a Farkouh, Michael E |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Xuesong |e verfasserin |4 aut | |
| 700 | 1 | |a Spertus, John A |e verfasserin |4 aut | |
| 700 | 1 | |a Ross, Heather J |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Douglas S |e verfasserin |4 aut | |
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