Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes
Abstract Aims Optimal management of heart failure with reduced ejection fraction (HFrEF) includes titration of guideline‐directed medical therapy (GDMT) to the highest tolerated dose within the licensed range. During hospitalization, GDMT doses are often significantly altered, although it is unknown...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-10-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14051 |
| _version_ | 1827915481646891008 |
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| author | Victoria Palin Michael Drozd Ellis Garland Anam Malik Sam Straw Melanie McGinlay Alexander Simms V. Kate Gatenby Anshuman Sengupta Eylem Levelt Klaus K. Witte Mark T. Kearney Richard M. Cubbon |
| author_facet | Victoria Palin Michael Drozd Ellis Garland Anam Malik Sam Straw Melanie McGinlay Alexander Simms V. Kate Gatenby Anshuman Sengupta Eylem Levelt Klaus K. Witte Mark T. Kearney Richard M. Cubbon |
| author_sort | Victoria Palin |
| collection | DOAJ |
| description | Abstract Aims Optimal management of heart failure with reduced ejection fraction (HFrEF) includes titration of guideline‐directed medical therapy (GDMT) to the highest tolerated dose within the licensed range. During hospitalization, GDMT doses are often significantly altered, although it is unknown whether the cause of hospitalization influences this. Methods and results We recruited 711 people with stable HFrEF from specialist heart failure clinics and prospectively assessed events occurring during first unplanned hospitalization. Dose changes of ACE inhibitors or angiotensin receptor blockers (ACEi/ARB), beta‐blockers, mineralocorticoid receptor antagonists, and loop diuretics were recorded during 414 hospitalizations, categorized as due to decompensated heart failure, other cardiovascular causes, infection, or other non‐cardiovascular causes. Most hospitalizations resulted in no change to GDMT. ACEi/ARB dose was reduced in 21% of hospitalizations and was more common during non‐cardiovascular hospitalization (25.4% vs. 13.9%; P = 0.005). ACEi/ARB dose reduction was associated with older age and lower left ventricular ejection fraction at study recruitment, and poorer renal function, lower systolic blood pressure, higher serum potassium, and less frequent care from a cardiologist during admission. People experiencing ACEi/ARB reduction had worse age‐adjusted survival after discharge, without differences in heart failure re‐hospitalization. De‐escalation of beta‐blockers occurred in 8% of hospitalizations, most often due to other non‐cardiovascular causes; this was not associated with post‐discharge survival or re‐hospitalization with heart failure. Conclusions De‐escalation of HFrEF GDMT is more common during non‐cardiovascular hospitalization and for ACEi/ARB is associated with reduced survival. Post‐discharge care plans should include robust plans to consider re‐escalation of GDMT in these cases. |
| first_indexed | 2024-03-13T03:01:07Z |
| format | Article |
| id | doaj.art-ea4dc3e51f694b5b944775bbbc1162b1 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-13T03:01:07Z |
| publishDate | 2022-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-ea4dc3e51f694b5b944775bbbc1162b12023-06-27T14:49:57ZengWileyESC Heart Failure2055-58222022-10-01953298330710.1002/ehf2.14051Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomesVictoria Palin0Michael Drozd1Ellis Garland2Anam Malik3Sam Straw4Melanie McGinlay5Alexander Simms6V. Kate Gatenby7Anshuman Sengupta8Eylem Levelt9Klaus K. Witte10Mark T. Kearney11Richard M. Cubbon12Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds Clarendon Way Leeds LS2 9JT UKLeeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds Clarendon Way Leeds LS2 9JT UKLeeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds Clarendon Way Leeds LS2 9JT UKLeeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds Clarendon Way Leeds LS2 9JT UKLeeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds Clarendon Way Leeds LS2 9JT UKDepartment of Cardiology Leeds Teaching Hospitals NHS Trust Leeds UKDepartment of Cardiology Leeds Teaching Hospitals NHS Trust Leeds UKDepartment of Cardiology Leeds Teaching Hospitals NHS Trust Leeds UKDepartment of Cardiology Leeds Teaching Hospitals NHS Trust Leeds UKLeeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds Clarendon Way Leeds LS2 9JT UKLeeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds Clarendon Way Leeds LS2 9JT UKLeeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds Clarendon Way Leeds LS2 9JT UKLeeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds Clarendon Way Leeds LS2 9JT UKAbstract Aims Optimal management of heart failure with reduced ejection fraction (HFrEF) includes titration of guideline‐directed medical therapy (GDMT) to the highest tolerated dose within the licensed range. During hospitalization, GDMT doses are often significantly altered, although it is unknown whether the cause of hospitalization influences this. Methods and results We recruited 711 people with stable HFrEF from specialist heart failure clinics and prospectively assessed events occurring during first unplanned hospitalization. Dose changes of ACE inhibitors or angiotensin receptor blockers (ACEi/ARB), beta‐blockers, mineralocorticoid receptor antagonists, and loop diuretics were recorded during 414 hospitalizations, categorized as due to decompensated heart failure, other cardiovascular causes, infection, or other non‐cardiovascular causes. Most hospitalizations resulted in no change to GDMT. ACEi/ARB dose was reduced in 21% of hospitalizations and was more common during non‐cardiovascular hospitalization (25.4% vs. 13.9%; P = 0.005). ACEi/ARB dose reduction was associated with older age and lower left ventricular ejection fraction at study recruitment, and poorer renal function, lower systolic blood pressure, higher serum potassium, and less frequent care from a cardiologist during admission. People experiencing ACEi/ARB reduction had worse age‐adjusted survival after discharge, without differences in heart failure re‐hospitalization. De‐escalation of beta‐blockers occurred in 8% of hospitalizations, most often due to other non‐cardiovascular causes; this was not associated with post‐discharge survival or re‐hospitalization with heart failure. Conclusions De‐escalation of HFrEF GDMT is more common during non‐cardiovascular hospitalization and for ACEi/ARB is associated with reduced survival. Post‐discharge care plans should include robust plans to consider re‐escalation of GDMT in these cases.https://doi.org/10.1002/ehf2.14051HospitalizationMedicationDoseNon‐cardiovascularPrognosis |
| spellingShingle | Victoria Palin Michael Drozd Ellis Garland Anam Malik Sam Straw Melanie McGinlay Alexander Simms V. Kate Gatenby Anshuman Sengupta Eylem Levelt Klaus K. Witte Mark T. Kearney Richard M. Cubbon Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes ESC Heart Failure Hospitalization Medication Dose Non‐cardiovascular Prognosis |
| title | Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes |
| title_full | Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes |
| title_fullStr | Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes |
| title_full_unstemmed | Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes |
| title_short | Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes |
| title_sort | reduction of heart failure guideline directed medication during hospitalization prevalence risk factors and outcomes |
| topic | Hospitalization Medication Dose Non‐cardiovascular Prognosis |
| url | https://doi.org/10.1002/ehf2.14051 |
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