J Korean Med Sci.  2019 May;34(17):e133. 10.3346/jkms.2019.34.e133.

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

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju College of Medicine, Wonju, Korea. yubs@yonsei.ac.kr
  • 2Center of Biomedical Data Science, Yonsei University, Wonju College of Medicine, Wonju, Korea.
  • 3Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  • 4Department of Internal Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea.
  • 5Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 6Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 7Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.

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.

Keyword

De Novo Acute Heart Failure; Acute Decompensated Heart Failure; Guideline-Directed Therapy
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