Etienne Gayat1, Mattia Arrigo1,2, Simona Littnerova3, Naoki Sato4, Jiri Parenica5, Shiro Ishihara4, Jindrich Spinar5, Christian Müller6, Veli-Pekka Harjola7, Johan Lassus8, Òscar Miró9, Aldo P Maggioni10, Khalid F AlHabib11, Dong-Ju Choi12, Jin Joo Park12, Yuhui Zhang13, Jian Zhang13, James L Januzzi14, Katsuya Kajimoto15, Alain Cohen-Solal16, Alexandre Mebazaa1. 1. Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot and INSERM UMR-S 942, Paris, France. 2. Division of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. 3. Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic. 4. Division of Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan. 5. Department of Cardiology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic. 6. Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, Basel, Switzerland. 7. Emergency Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland. 8. Division of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland. 9. Emergency Department, Hospital Clinic and 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain. 10. ANMCO Research Center, Florence, Italy. 11. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia. 12. Division Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea. 13. Heart Failure Center Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 14. Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 15. Division of Cardiology, Sekikawa Hospital, Tokyo, Japan. 16. Department of Cardiology, APHP - Lariboisière University Hospital, and INSERM UMR-S 942, Paris, France.
Abstract
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.
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.
Authors: Ovidiu Chioncel; Sean P Collins; Andrew P Ambrosy; Peter S Pang; Elena-Laura Antohi; Vlad Anton Iliescu; Aldo P Maggioni; Javed Butler; Alexandre Mebazaa Journal: Am J Ther Date: 2018 Jul/Aug Impact factor: 2.688
Authors: Òscar Miró; Xavier Rossello; Elke Platz; Josep Masip; Danielle M Gualandro; W Frank Peacock; Susanna Price; Louise Cullen; Salvatore DiSomma; Mucio Tavares de Oliveira; John Jv McMurray; Francisco J Martín-Sánchez; Alan S Maisel; Christiaan Vrints; Martin R Cowie; Héctor Bueno; Alexandre Mebazaa; Christian Mueller Journal: Eur Heart J Acute Cardiovasc Care Date: 2020-08
Authors: Lauren G Gilstrap; Lynne W Stevenson; Roy Small; Ron Parambi; Rose Hamershock; Jeffrey Greenberg; Christina Carr; Roya Ghazinouri; Lisa Rathman; Elizabeth Han; Mandeep R Mehra; Akshay S Desai Journal: J Am Heart Assoc Date: 2018-08-07 Impact factor: 5.501