Publication details

Heart failure oral therapies at discharge are associated with better outcome in acute heart failure: a propensity-score matched study

Title in English Heart failure oral therapies at discharge are associated with better outcome in acute heart failure: A propensity-score matched study
Authors

GAYAT Etienne ARRIGO Mattia LITTNEROVÁ Simona SATO Naoki PAŘENICA Jiří ISHIHARA Shiro ŠPINAR Jindřich MULLER Christian HARJOLA Veli-Pekka LASSUS Johan MIRO Oscar MAGGIONI Aldo P. ALHABIB Khalid F. CHOI Dong-Ju PARK Jin Joo ZHANG Yuhui ZHANG Jian JANUZZI James L., Jr. KAJIMOTO Katsuya COHEN-SOLAL Alain MEBAZAA Alexandre

Year of publication 2018
Type Article in Periodical
Magazine / Source European Journal of heart Failure
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1002/ejhf.932
Field Cardiovascular diseases incl. cardiosurgery
Keywords Acute heart failure; Prognosis; Oral therapy
Description 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.& para;& para;Methods and results The study population was composed of 19 980 AHF patients from the GREAT registry. The primary and secondary and results 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.& para;& para;Conclusions Administration of HFOTs at hospital discharge is associated with better survival of AHF patients.
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