Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure
10.3346/jkms.2019.34.e133
- Author:
Min Soo AHN
1
;
Byung Su YOO
;
Junghan YOON
;
Seung Hwan LEE
;
Jang Young KIM
;
Sung Gyun AHN
;
Young Jin YOUN
;
Jun Won LEE
;
Jung Woo SON
;
Hye Sim KIM
;
Dae Ryong KANG
;
Sang Eun LEE
;
Hyun Jai CHO
;
Hae Young LEE
;
Eun Seok JEON
;
Seok Min KANG
;
Dong Ju CHOI
;
Myeong Chan CHO
Author Information
1. Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju College of Medicine, Wonju, Korea. yubs@yonsei.ac.kr
- Publication Type:Multicenter Study
- Keywords:
De Novo Acute Heart Failure;
Acute Decompensated Heart Failure;
Guideline-Directed Therapy
- MeSH:
Angiotensins;
Cohort Studies;
Heart Failure;
Heart;
Humans;
Mortality;
Receptors, Mineralocorticoid
- From:Journal of Korean Medical Science
2019;34(17):e133-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. METHODS: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. RESULTS: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34–0.95), mortality (HR, 0.41; 95% CI, 0.24–0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36–0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41–0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47–0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. CONCLUSION: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.
