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Heart failure oral therapies at discharge are associated with better outcome in acute heart failure: a propensity‐score matched study
Author(s) -
Gayat Etienne,
Arrigo Mattia,
Littnerova Simona,
Sato Naoki,
Parenica Jiri,
Ishihara Shiro,
Spinar Jindrich,
Müller Christian,
Harjola VeliPekka,
Lassus Johan,
Miró Òscar,
Maggioni Aldo P.,
AlHabib Khalid F.,
Choi DongJu,
Park Jin Joo,
Zhang Yuhui,
Zhang Jian,
Januzzi James L.,
Kajimoto Katsuya,
CohenSolal Alain,
Mebazaa Alexandre
Publication year - 2018
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.932
Subject(s) - medicine , heart failure , hazard ratio , propensity score matching , confidence interval , ejection fraction , proportional hazards model , population , cardiology , environmental health
Aims Heart failure oral therapies (HFOTs), including beta‐blockers (BB), renin–angiotensin system inhibitors (RASi) and mineralocorticoid receptor antagonists, administered before hospital discharge after acute heart failure (AHF) might improve outcome. However, concerns have been raised because early administration of HFOTs may worsen patient's condition. We hypothesized that HFOTs at hospital discharge might be associated with better post‐discharge survival. Methods and results The study population was composed of 19 980 AHF patients from the GREAT registry. The primary and secondary outcomes were 90‐day and 1‐year all‐cause mortality, respectively. Survival was estimated with univariate and covariate‐adjusted Cox proportional hazards regression models for the whole population and after propensity‐score matching. HFOTs at discharge were consistently associated with no excess mortality in the unadjusted and adjusted analyses of the whole and matched cohorts. In the matched cohort, BB and RASi at discharge were associated with lower 90‐day mortality risks compared to the respective untreated groups [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.46–0.69; and HR 0.53, 95% CI 0.42–0.66, respectively]. The favourable associations of BB and RASi at discharge with 90‐day mortality were present in many subgroups including patients with reduced or preserved left ventricular ejection fraction and persisted up to 1 year after discharge. The combination of RASi and BB was associated with an even lower risk of death than RASi or BB alone. Conclusions Administration of HFOTs at hospital discharge is associated with better survival of AHF patients.