Impact of adherence to guideline‐directed therapy on risk of death in HF patients across an ejection fraction spectrum
Abstract Aims How different degrees of adherence to guideline‐directed medical therapy (GDMT) affect mortality risk in patients with heart failure (HF) in a real‐world clinical setting is poorly understood. This study sought to investigate how different levels of adherence to GDMT were associated wi...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-12-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14358 |
| _version_ | 1797449243788574720 |
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| author | Xiaojing Chen Yu Kang Ulf Dahlström Michael Fu |
| author_facet | Xiaojing Chen Yu Kang Ulf Dahlström Michael Fu |
| author_sort | Xiaojing Chen |
| collection | DOAJ |
| description | Abstract Aims How different degrees of adherence to guideline‐directed medical therapy (GDMT) affect mortality risk in patients with heart failure (HF) in a real‐world clinical setting is poorly understood. This study sought to investigate how different levels of adherence to GDMT were associated with the risk of all‐cause mortality in patients with HF across a spectrum of left ventricular ejection fractions (LVEFs) in a real‐world clinical setting. Methods and results A total of 64 610 HF patients with no missing value of LVEF from the Swedish Heart Failure Registry were included in the study. Patients were divided according to different LVEFs (<30%, 30–39%, 40–49%, and≥50%) and stratified by an adherence score (good, moderate, or poor) according to the triple, double, and single one usage of GDMT: angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, beta‐blockers, and mineralocorticoid receptor antagonists. The outcome is time to all‐cause mortality. The mean age of the whole cohort was 73.9 ± 12.1 years, and the proportion of patients in LVEF < 30%, 30–39%, 40–49%, and≥50% groups was 27.6%, 26.9%, 22.1%, and 23.3%, respectively. Patients with LVEF < 30% had the highest mortality rate, almost 20% higher than those with LVEF ≥ 50% {hazard ratio [HR] [95% confidence interval (CI)]: 0.80 [0.71–0.90], P < 0.001}. After treatment of GDMT with good adherence, patients with LVEF < 30% had similar mortality to those with LVEF ≥ 50% [HR (95% CI): 0.97 (0.86–1.10), P = 0.664]. However, the percentage of moderate or poor GDMT was alarmingly high, with good adherence only in 20% of the patients. Conclusions Good adherence to GDMT works best in patients with LVEF < 50%, whereas moderate adherence to GDMT varies in efficacy depending on the components of the drug combinations. |
| first_indexed | 2024-03-09T14:23:14Z |
| format | Article |
| id | doaj.art-e9952badbdc94847af7c981ebd555d36 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-09T14:23:14Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-e9952badbdc94847af7c981ebd555d362023-11-28T09:37:49ZengWileyESC Heart Failure2055-58222023-12-011063656366610.1002/ehf2.14358Impact of adherence to guideline‐directed therapy on risk of death in HF patients across an ejection fraction spectrumXiaojing Chen0Yu Kang1Ulf Dahlström2Michael Fu3Department of Cardiology West China Hospital, Sichuan University Chengdu Sichuan ChinaDepartment of Cardiology West China Hospital, Sichuan University Chengdu Sichuan ChinaDepartment of Cardiology Linköping University Linköping SwedenDepartment of Molecular and Clinical Medicine, Institute of Medicine Sahlgrenska Academy, University of Gothenburg Gothenburg SwedenAbstract Aims How different degrees of adherence to guideline‐directed medical therapy (GDMT) affect mortality risk in patients with heart failure (HF) in a real‐world clinical setting is poorly understood. This study sought to investigate how different levels of adherence to GDMT were associated with the risk of all‐cause mortality in patients with HF across a spectrum of left ventricular ejection fractions (LVEFs) in a real‐world clinical setting. Methods and results A total of 64 610 HF patients with no missing value of LVEF from the Swedish Heart Failure Registry were included in the study. Patients were divided according to different LVEFs (<30%, 30–39%, 40–49%, and≥50%) and stratified by an adherence score (good, moderate, or poor) according to the triple, double, and single one usage of GDMT: angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, beta‐blockers, and mineralocorticoid receptor antagonists. The outcome is time to all‐cause mortality. The mean age of the whole cohort was 73.9 ± 12.1 years, and the proportion of patients in LVEF < 30%, 30–39%, 40–49%, and≥50% groups was 27.6%, 26.9%, 22.1%, and 23.3%, respectively. Patients with LVEF < 30% had the highest mortality rate, almost 20% higher than those with LVEF ≥ 50% {hazard ratio [HR] [95% confidence interval (CI)]: 0.80 [0.71–0.90], P < 0.001}. After treatment of GDMT with good adherence, patients with LVEF < 30% had similar mortality to those with LVEF ≥ 50% [HR (95% CI): 0.97 (0.86–1.10), P = 0.664]. However, the percentage of moderate or poor GDMT was alarmingly high, with good adherence only in 20% of the patients. Conclusions Good adherence to GDMT works best in patients with LVEF < 50%, whereas moderate adherence to GDMT varies in efficacy depending on the components of the drug combinations.https://doi.org/10.1002/ehf2.14358Heart failureLeft ventricular ejection fractionGuideline‐directed medical therapyAll‐cause mortality |
| spellingShingle | Xiaojing Chen Yu Kang Ulf Dahlström Michael Fu Impact of adherence to guideline‐directed therapy on risk of death in HF patients across an ejection fraction spectrum ESC Heart Failure Heart failure Left ventricular ejection fraction Guideline‐directed medical therapy All‐cause mortality |
| title | Impact of adherence to guideline‐directed therapy on risk of death in HF patients across an ejection fraction spectrum |
| title_full | Impact of adherence to guideline‐directed therapy on risk of death in HF patients across an ejection fraction spectrum |
| title_fullStr | Impact of adherence to guideline‐directed therapy on risk of death in HF patients across an ejection fraction spectrum |
| title_full_unstemmed | Impact of adherence to guideline‐directed therapy on risk of death in HF patients across an ejection fraction spectrum |
| title_short | Impact of adherence to guideline‐directed therapy on risk of death in HF patients across an ejection fraction spectrum |
| title_sort | impact of adherence to guideline directed therapy on risk of death in hf patients across an ejection fraction spectrum |
| topic | Heart failure Left ventricular ejection fraction Guideline‐directed medical therapy All‐cause mortality |
| url | https://doi.org/10.1002/ehf2.14358 |
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