Evidence‐based pharmacotherapies used in the postdischarge phase are associated with improved one‐year survival in senior patients hospitalized with heart failure

Summary Aim Hospitalized heart failure ( HF ) patients have a poor prognosis postdischarge. We determined whether renin‐angiotensin system inhibitors ( RASI ) and β‐blockers dispensed to patients within 60 days post‐ HF hospital discharge are associated with improved 1‐year survival. Methods A retrospective population‐based study was conducted in 4897 seniors, aged 65‐84 years, alive at 60 days postindex HF hospitalization in Western Australia over 2003‐2008. Dispensing of RASI and β‐blocker dispensing was identified from the Pharmaceutical Benefits Scheme claims database linked to hospital admission and death records. Results At 1‐year posthospital discharge, the all‐cause mortality and all‐cause death or HF rehospitalization rate was 13.5% (n = 663) and 24.4% (n = 1193), respectively. Postdischarge RASI and β‐blocker were dispensed in 77.4% and 53.0% of patients, respectively. Their use was associated with a lower inverse probability treatment weighted ( IPTW ) HR for 1‐year mortality of 0.70, 95% CI 0.61‐0.81 and 0.79, 95% CI 0.68‐0.92, respectively (both P  < 0.0001), with a survival advantage most evident in the subgroup (70.1%) of patients with ischemic HF . In the overall cohort, these therapies were also associated with reduced IPTW HR s for all‐cause death or HF rehospitalization (both P  < 0.005) but not for HF rehospitalization exclusively. Use of a β‐blocker was associated with a reduced IPTW HR for HF rehospitalization in the ischemic HF subgroup only. Conclusions In a cohort of senior patients hospitalized with HF , dispensing of a RASI or β‐blocker within 60 days postdischarge is associated with a 1‐year survival benefit. Early postdischarge support programs after recent HF hospitalization should include measures to optimize adherence to evidence‐based medications.