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| Página principal > Artículos > Artículos publicados > Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation |
(Hospital Universitari MútuaTerrassa (Terrassa, Catalunya)) (Hospital General Universitario de Alicante (Alacant, País Valencià)) (Momentum Research. Durham) (Hospital Universitari de Bellvitge) (Hospital Universitario Central de Asturias) (Hospital Clínico San Carlos (Madrid)) (Institut d'Investigació Biomèdica Sant Pau) (Instituto de Investigación Sanitaria y Biomédica de Alicante) (University of Medicine Carol Davila)| Fecha: | 2021 |
| Resumen: | Aims: To analyze the frequency with which patients with heart failure with preserved ejection fraction (HFpEF) discharged after an acute heart failure (AHF) episode are treated with antineurohormonal drugs (ANHD), the variables related to ANHD prescription and their relationship with outcomes. Methods: We included consecutive HFpEF patients (left ventricular ejection fraction ≥50%) discharged after an AHF episode from 45 Spanish hospitals whose chronic medications and treatment at discharge were available. Patients were classified according to whether they were discharged with or without ANHD, including beta-blockers (BB), renin-angiotensin-aldosterone-system inhibitors (RAASi) and mineralcorticosteroid-receptor antagonists (MRA). Co-primary outcomes consisted of 1-year all-cause mortality and 90-day combined adverse event (revisit to emergency department -ED-, hospitalization due to AHF or all-cause death). Secondary outcomes were 90-day adverse events taken individually. Adjusted associations of ANHD treatment with outcomes were calculated. Results: We analyzed 3,305 patients with HFpEF (median age: 83, 60% women), 2,312 (70%) discharged with ANHD. The ANHD most frequently prescribed was BB (45. 8%). The 1-year mortality was 26. 9% (adjusted HR for ANHD patients:1. 17, 95%CI=0. 98-1. 38) and the 90-day combined adverse event was 54. 4% (HR=1. 14, 95%CI=0. 99-1. 31). ED revisit was significantly increased by ANHD (HR=1. 15, 95%CI=1. 01-1. 32). MRA and BB were associated with worse results in some co-primary or secondary endpoints, while RAASi (alone) reduced 90-day hospitalization (HR=0. 73, 98%CI=0. 56-0. 96). Conclusion: 70% of HFpEF patients are discharged with ANHD after an AHF episode. ANHD do not seem to reduce mortality or adverse events in HFpEF patients, only RAASi could provide some benefits, reducing the risk of hospitalization for AHF. |
| Ayudas: | Instituto de Salud Carlos III PI15/01019 Instituto de Salud Carlos III PI15/00773 Instituto de Salud Carlos III PI18/00393 Instituto de Salud Carlos III PI18/00456 Agència de Gestió d'Ajuts Universitaris i de Recerca SGR 2009/1385 Agència de Gestió d'Ajuts Universitaris i de Recerca SGR 2014/0313 Agència de Gestió d'Ajuts Universitaris i de Recerca 2017/1424 |
| Nota: | Altres ajuts: Ministerio de Sanidad; Fondo Europeo de Desarrollo Regional (FEDER); Fundació La Marató de TV3 (2015/2510); Novartis; Orion Pharma. |
| Derechos: | Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.  |
| Lengua: | Anglès |
| Documento: | Article ; recerca ; Versió publicada |
| Materia: | Acute heart failure ; Antineurohormonal drugs ; Preserved ejection fraction ; Prognosis ; Emergency departments |
| Publicado en: | European Journal of Internal Medicine, Vol. 94 (december 2021) , p. 73-84, ISSN 1879-0828 |
