Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure

• Published in: Journal of Korean medical science Vol. 34; no. 17; pp. e133 - 12
• Main Authors: Ahn, Min-Soo, Yoo, Byung-Su, Yoon, Junghan, Lee, Seung-Hwan, Kim, Jang-Young, Ahn, Sung Gyun, Youn, Young Jin, Lee, Jun-Won, Son, Jung-Woo, Kim, Hye Sim, Kang, Dae Ryong, Lee, Sang Eun, Cho, Hyun-Jai, Lee, Hae-Young, Jeon, Eun-Seok, Kang, Seok-Min, Choi, Dong-Ju, Cho, Myeong-Chan
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 06.05.2019; 대한의학회
• Subjects: Acute Disease; Adrenergic beta-Antagonists - therapeutic use; Aged; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Atrial Natriuretic Factor - analysis; Cohort Studies; Female; Guideline Adherence; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - mortality; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Mineralocorticoid Receptor Antagonists - therapeutic use; Original; Patient Discharge; Prognosis; Proportional Hazards Models; Prospective Studies; Protein Precursors - analysis; Registries; Survival Rate; 의학일반; De Novo Acute Heart Failure; Acute Decompensated Heart Failure; Guideline-Directed Therapy
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2019.34.e133

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 acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. 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. In 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. The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.