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Effectiveness of guideline-consistent heart failure drug prescriptions at hospital discharge on 1-year mortality: Results from the EPICAL2 cohort study

Published:January 02, 2018DOI:https://doi.org/10.1016/j.ejim.2017.12.005

      Highlights

      • Prescription of ACE inhibitors and β-blockers for patients with HFREF was low
      • A drop of recommended drug prescription in HREF might occur late after discharge
      • ACE inhibitors and β-blockers in HFREF might remain effective in current practice

      Abstract

      Background

      We aimed to assess the effectiveness of recommended drug prescriptions at hospital discharge on 1-year mortality in patients with heart failure (HF) and reduced ejection fraction (HFREF).

      Materials and methods

      We used data from the EPICAL2 cohort study. HF patients ≥18 years old with left ventricular ejection fraction (LVEF) <40% and alive at discharge were included and followed up for mortality. Socio-demographic, clinical and therapeutic data were collected at admission. Therapeutic data were collected at discharge and at 6 month. Prescription of an angiotensin-converting enzyme (ACE) inhibitor (or an angiotensin II receptor blocker [ARB] in case of ACE inhibitor intolerance) and a β-blocker at discharge were considered “guideline-consistent discharge prescription” (GCDP). A frailty Cox model after propensity score (PS) matching was used to assess the association of GCDP with survival.

      Results

      Among 624 patients included, the mean (SD) age was 73.6 (12.8) years; 65% were male. A total of 412 (65.6%) patients received GCDP, and 82.8% still had guideline consistent prescription at 6 months. A total of 166 patients died during the follow-up, 78 in the GCDP group and 88 in the other group. Before PS matching, patients with GCDP were younger (|StDiff| = 48.32%) and had higher body mass index (BMI) (|StDiff| = 11.71%), lower LVEF (|StDiff| = 23.13%) and lower Charlson index (|StDiff| = 55.27%) than patients without GCDP. After PS matching, all characteristics were balanced between the two treatment groups, and GCDP was associated with reduced mortality (pooled HR = 0.51, 95% CI [0.35–0.73]).

      Conclusion

      Prescription of ACE (or ARB) inhibitors and β-blockers for patients with HFREF may be low despite the evidence for morbidity and mortality improvement with these medications but remains associated with reduced 1-year mortality in unselected HFREF patients.

      Keywords

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      References

      1. N Engl J Med. 1987 Jun 4; 316: 1429-1435
        • Packer M.
        • Fowler M.B.
        • Roecker E.B.
        • Coats A.J.S.
        • Katus H.A.
        • Krum H.
        • et al.
        Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study.
        Circulation. 2002 Oct 22; 106: 2194-2199
        • Maggioni A.P.
        • Anand I.
        • Gottlieb S.O.
        • Latini R.
        • Tognoni G.
        • Cohn J.N.
        • et al.
        Effects of valsartan on morbidity and mortality in patients with heart failure not receiving angiotensin-converting enzyme inhibitors.
        J Am Coll Cardiol. 2002 Oct 16; 40: 1414-1421
        • Dickstein K.
        • Cohen-Solal A.
        • Filippatos G.
        • JJV McMurray
        • Ponikowski P.
        • Poole-Wilson P.A.
        • et al.
        ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).
        Eur J Heart Fail. 2008 Oct; 10: 933-989
        • McMurray J.J.V.
        • Adamopoulos S.
        • Anker S.D.
        • Auricchio A.
        • Böhm M.
        • Dickstein K.
        • et al.
        ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC.
        Eur J Heart Fail. 2012 Aug; 14: 803-869
        • Ponikowski P.
        • Voors A.A.
        • Anker S.D.
        • Bueno H.
        • Cleland J.G.F.
        • Coats A.J.S.
        • et al.
        2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the heart failure association (HFA) of the ESC.
        Eur Heart J. 2016 Jul 14; 37: 2129-2200
        • Komajda M.
        • Forette F.
        • Aupetit J.F.
        • Bénétos A.
        • Berrut G.
        • Emeriau J.P.
        • et al.
        Recommendations for the diagnosis and management of cardic failure in the elderly subject.
        Arch Mal Coeur Vaiss. 2004 Aug; 97: 803-822
        • Braunstein J.B.
        • Anderson G.F.
        • Gerstenblith G.
        • Weller W.
        • Niefeld M.
        • Herbert R.
        • et al.
        Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure.
        J Am Coll Cardiol. 2003 Oct 1; 42: 1226-1233
        • Lang C.C.
        • Mancini D.M.
        Non-cardiac comorbidities in chronic heart failure.
        Heart. 2007 Jun; 93: 665-671
        • Murray M.D.
        • Young J.
        • Hoke S.
        • Tu W.
        • Weiner M.
        • Morrow D.
        • et al.
        Pharmacist intervention to improve medication adherence in heart failure: a randomized trial.
        Ann Intern Med. 2007 May 15; 146: 714-725
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.A.
        New method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Austin P.C.
        Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.
        Stat Med. 2009 Nov 10; 28: 3083-3107
        • Austin P.C.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivar Behav Res. 2011 May; 46: 399-424
        • Austin P.C.
        Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.
        Pharm Stat. 2011 Apr; 10: 150-161
        • Neubauer S.
        • Schilling T.
        • Zeidler J.
        • Lange A.
        • Engel S.
        • Linder R.
        • et al.
        Impact of guideline adherence on mortality in treatment of left heart failure.
        Herz. 2016 Nov; 41: 614-624
        • Marzluf B.A.
        • Reichardt B.
        • Neuhofer L.M.
        • Kogler B.
        • Wolzt M.
        Influence of drug adherence and medical care on heart failure outcome in the primary care setting in Austria.
        Pharmacoepidemiol Drug Saf. 2015 Jul; 24: 722-730
        • Dahlstrom U.
        • Hakansson J.
        • Swedberg K.
        • Waldenstrom A.
        Adequacy of diagnosis and treatment of chronic heart failure in primary health care in Sweden.
        Eur J Heart Fail. 2009 Jan; 11: 92-98
        • Komajda M.
        • Follath F.
        • Swedberg K.
        • Cleland J.
        • Aguilar J.C.
        • Cohen-Solal A.
        • et al.
        The EuroHeart failure survey programme—a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment.
        Eur Heart J. 2003 Mar; 24: 464-474
        • Maggioni A.P.
        • Anker S.D.
        • Dahlström U.
        • Filippatos G.
        • Ponikowski P.
        • Zannad F.
        • et al.
        Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC heart failure long-term registry.
        Eur J Heart Fail. 2013 Oct; 15: 1173-1184
        • Maggioni A.P.
        • Dahlström U.
        • Filippatos G.
        • Chioncel O.
        • Leiro M.C.
        • Drozdz J.
        • et al.
        EURObservational research programme: the heart failure pilot survey (ESC-HF pilot).
        Eur J Heart Fail. 2010 Oct; 12: 1076-1084
        • Sueta C.A.
        • Rodgers J.E.
        • Chang P.P.
        • Zhou L.
        • Thudium E.M.
        • Kucharska-Newton A.M.
        • et al.
        Medication adherence based on Part D claims for patients with heart failure after hospitalization (from the atherosclerosis risk in communities study).
        Am J Cardiol. 2015 Aug 1; 116: 413-419
        • Ahluwalia S.C.
        • Gross C.P.
        • Chaudhry S.I.
        • Ning Y.M.
        • Leo-Summers L.
        • Van Ness P.H.
        • et al.
        Impact of comorbidity on mortality among older persons with advanced heart failure.
        J Gen Intern Med. 2012 May; 27: 513-519
        • Setoguchi S.
        • Choudhry N.K.
        • Levin R.
        • Shrank W.H.
        • Winkelmayer W.C.
        Temporal trends in adherence to cardiovascular medications in elderly patients after hospitalization for heart failure.
        Clin Pharmacol Ther. 2010 Oct; 88: 548-554
        • Shoukat S.
        • Gowani S.A.
        • Taqui A.M.
        • Ul Hassan R.
        • Bhutta Z.A.
        • Malik A.I.
        • et al.
        Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure—a national survey of the cardiologists in Pakistan.
        BMC Cardiovasc Disord. 2011 Nov 17; 11: 68
        • Fonarow G.C.
        • Albert N.M.
        • Curtis A.B.
        • Stough W.G.
        • Gheorghiade M.
        • Heywood J.T.
        • et al.
        Improving evidence-based care for heart failure in outpatient cardiology practices: primary results of the registry to improve the use of evidence-based heart failure therapies in the outpatient setting (IMPROVE HF).
        Circulation. 2010 Aug 10; 122: 585-596
        • Agrinier N.
        • Altieri C.
        • Alla F.
        • Jay N.
        • Dobre D.
        • Thilly N.
        • et al.
        Effectiveness of a multidimensional home nurse led heart failure disease management program—a French nationwide time-series comparison.
        Int J Cardiol. 2013 Oct 9; 168: 3652-3658
        • Roger V.L.
        • Weston S.A.
        • Redfield M.M.
        • Hellermann-Homan J.P.
        • Killian J.
        • Yawn B.P.
        • et al.
        Trends in heart failure incidence and survival in a community-based population.
        JAMA. 2004 Jul 21; 292: 344-350
        • Zannad F.
        • McMurray J.J.V.
        • Krum H.
        • van Veldhuisen D.J.
        • Swedberg K.
        • Shi H.
        • et al.
        Eplerenone in patients with systolic heart failure and mild symptoms.
        N Engl J Med. 2011 Jan 6; 364: 11-21
        • McMurray J.J.V.
        • Packer M.
        • Desai A.S.
        • Gong J.
        • Lefkowitz M.P.
        • Rizkala A.R.
        • et al.
        Angiotensin-neprilysin inhibition versus enalapril in heart failure.
        N Engl J Med. 2014 Sep 11; 371: 993-1004