Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation

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. Metho...

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Authors: Tost, J, Llorens, P, Cotter, G, Davison, B, Jacob, J, Gil, V, Herrero, P, Martin-Sanchez, FJ, Donea, R, Rodriguez, B, Lucas-Imbernon, FJ, Andueza, JA, Mecina, AB, Torres-Garate, R, Pinera, P, Alquezar-Arbe, A, Espinosa, B, Mebazaa, A, Chioncel, O, Miro, O
Format: article
Status:Published version
Publication Date:2021
Country:España
Institution:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repository:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p5272
Online Access:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5272
https://ddd.uab.cat/record/270203
Access Level:Open access
Keyword:Acute heart failure
Antineurohormonal drugs
Preserved ejection fraction
Prognosis
Emergency departments
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spelling Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensationTost, JLlorens, PCotter, GDavison, BJacob, JGil, VHerrero, PMartin-Sanchez, FJDonea, RRodriguez, BLucas-Imbernon, FJAndueza, JAMecina, ABTorres-Garate, RPinera, PAlquezar-Arbe, AEspinosa, BMebazaa, AChioncel, OMiro, OAcute heart failureAntineurohormonal drugsPreserved ejection fractionPrognosisEmergency departmentsAims: 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.ELSEVIER2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5272https://ddd.uab.cat/record/270203European Journal of Internal MedicineISSN: 09536205ISSNe: 18790828reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p52722026-06-14T12:41:47Z
dc.title.none.fl_str_mv Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
title Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
spellingShingle Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
Tost, J
Acute heart failure
Antineurohormonal drugs
Preserved ejection fraction
Prognosis
Emergency departments
title_short Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
title_full Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
title_fullStr Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
title_full_unstemmed Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
title_sort Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
dc.creator.none.fl_str_mv Tost, J
Llorens, P
Cotter, G
Davison, B
Jacob, J
Gil, V
Herrero, P
Martin-Sanchez, FJ
Donea, R
Rodriguez, B
Lucas-Imbernon, FJ
Andueza, JA
Mecina, AB
Torres-Garate, R
Pinera, P
Alquezar-Arbe, A
Espinosa, B
Mebazaa, A
Chioncel, O
Miro, O
author Tost, J
author_facet Tost, J
Llorens, P
Cotter, G
Davison, B
Jacob, J
Gil, V
Herrero, P
Martin-Sanchez, FJ
Donea, R
Rodriguez, B
Lucas-Imbernon, FJ
Andueza, JA
Mecina, AB
Torres-Garate, R
Pinera, P
Alquezar-Arbe, A
Espinosa, B
Mebazaa, A
Chioncel, O
Miro, O
author_role author
author2 Llorens, P
Cotter, G
Davison, B
Jacob, J
Gil, V
Herrero, P
Martin-Sanchez, FJ
Donea, R
Rodriguez, B
Lucas-Imbernon, FJ
Andueza, JA
Mecina, AB
Torres-Garate, R
Pinera, P
Alquezar-Arbe, A
Espinosa, B
Mebazaa, A
Chioncel, O
Miro, O
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Acute heart failure
Antineurohormonal drugs
Preserved ejection fraction
Prognosis
Emergency departments
topic Acute heart failure
Antineurohormonal drugs
Preserved ejection fraction
Prognosis
Emergency departments
description 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.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5272
https://ddd.uab.cat/record/270203
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5272
https://ddd.uab.cat/record/270203
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER
publisher.none.fl_str_mv ELSEVIER
dc.source.none.fl_str_mv European Journal of Internal Medicine
ISSN: 09536205
ISSNe: 18790828
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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