Effect of Optimizing Guideline-Directed Medical Therapy Before Discharge on Mortality and Heart Failure Readmission in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

Yamaguchi, Tetsuo; Kitai, Takeshi; Miyamoto, Takamichi; Kagiyama, Nobuyuki; Okumura, Takahiro; Kida, Kenji; Oishi, Shogo; Akiyama, Eiichi; Suzuki, Satoshi; Yamamoto, Masayoshi; Yamaguchi, Junji; Iwai, Takamasa; Hijikata, Sadahiro; Masuda, Ryosuke; Miyazaki, Ryoichi; Hara, Nobuhiro; Nagata, Yasutoshi; Nozato, Toshihiro; Matsue, Yuya

doi:10.1016/j.amjcard.2018.01.006

Cited by 48 publications

(47 citation statements)

References 24 publications

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“…Two observational studies have provided some evidence of a link between dose optimization and improved outcomes, including mortality, but these were limited to a European perspective. Two recent studies, one in a Medicare population in the US and the other in a Japanese population, suggest that initiation and continuation of ACEIs and BBs are associated with reduced mortality up to 1 year but not with hospitalizations. Clinical trials have also provided some evidence of the benefits of dose optimization of individual agents on mortality and hospitalization (lisinopril, losartan, carvedilol), while other studies of metoprolol CR/XL and bisoprolol have demonstrated similar risk reduction, irrespective of dosage .…”

Section: Discussionmentioning

confidence: 99%

“…Although there is evidence that good adherence to HF treatment guidelines is associated with better short‐term cardiovascular (CV) mortality and hospitalization, international data on the longer‐term association of adherence to guidelines with clinical outcomes are scarce. Two recent publications suggest that initiation and continuation of angiotensin‐converting enzyme inhibitors (ACEIs) and beta‐blockers (BBs) reduced 1‐year mortality but not readmission rates in a North American and in a Japanese population …”

Section: Introductionmentioning

confidence: 99%

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Physicians' guideline adherence is associated with long‐term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry

Komajda

Schöpe

Wagenpfeil

et al. 2019

European J of Heart Fail

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Background Physicians' adherence to guideline‐recommended therapy is associated with short‐term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer‐term outcomes is poorly documented. Here, we present results from the 18‐month follow‐up of the QUALIFY registry. Methods and results Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed for five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF‐related (191/394) and the same was true for unplanned hospitalizations (1175 CV and 861 HF‐related hospitalizations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87–0.99 per 0.1 unit adherence level increase; P = 0.034] as was composite of HF hospitalization or CV death (SHR 0.97, 95% CI 0.94–0.99 per 0.1 unit adherence level increase; P = 0.043), whereas unplanned all‐cause, CV or HF hospitalizations were not (all‐cause: SHR 0.99, 95% CI 0.9–1.02; CV: SHR 0.98, 95% CI 0.96–1.01; and HF: SHR 0.99, 95% CI 0.96–1.02 per 0.1 unit change in adherence score; P = 0.52, P = 0.2, and P = 0.4, respectively). Conclusion These results suggest that physicians' adherence to guideline‐recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians' adherence to guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Physicians' guideline adherence is associated with long‐term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry

Komajda

Schöpe

Wagenpfeil

et al. 2019

European J of Heart Fail

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“…A recent observation report of optimization of GDMT following hospitalization showed, reduced 1 year mortality but no reduction of hospital readmission for heart failure …”

Section: Effect Of Gdmt On Morbidity Compression In Heart Failurementioning

confidence: 99%

GDMT for heart failure and the clinician's conundrum

Samarendra

2019

Clinical Cardiology

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Therapeutic advances in management of CHF have decreased mortality and have impacted progression in patients with mild to moderate heart failure. Aggressive campaigns by cardiology societies aimed at increasing implementation of these measures in routine practices have almost generalized the treatment of heart failure irrespective of individual variations of clinical status of patients and stages of heart failure. This explains why morbidity compression and quality of life improvement have not been realized fully particularly in patients with advanced disease. To examine whether GDMT for CHF is backed by unambiguous evidence of clinical efficacy for its global implementation in every patient at all stages of the syndrome. ACC/AHA, ESC Guidelines for CHF, and their updates were reviewed. Clinical trial cited in the guideline documents and other pertaining published literatures were analyzed.FindingsMany of the recommended GDMT for CHF lack unequivocal evidence of clinical efficacy in patients with diverge etiology of heart failure and concomitant comorbid conditions Some of the recommendations which are useful in early stages, lack evidence of efficacy in more advanced stages of heart failure. Application of results of research trials in patients beyond their inclusion and exclusion criteria, appears mere extrapolation, Clinicians are faced with the conundrum of implementing the recommendations without indubitable evidence of their efficacy in every patient of their practice.ConclusionA reappraisal of Guidelines is needed to address outstanding questions pertaining to the efficacy of recommendations and plug the knowledge gaps without assumption and extrapolation of results of RCTs beyond their inclusion and exclusion criteria.

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“…The present study utilized data from the REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure), a prospective multicenter registry focused on presentation and treatment during the very early phase of AHF hospitalization. Details regarding the study design have been published elsewhere [4,[11][12][13][14][15][16]. Briefly, consecutive patients with AHF aged �20 years who were hospitalized via the emergency department (ED) at 20 hospitals in Japan were enrolled.…”

Section: Study Participantsmentioning

confidence: 99%

Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure

et al. 2020

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The prognostic impact of worsening renal function (WRF) in patients with acute heart failure (AHF) remains under debate. Successful decongestion might offset the negative impact of WRF, but little is known about indicators of successful decongestion in the very acute phase of AHF. We hypothesized that decongestion as evaluated by the percent reduction in brain natriuretic peptide (BNP) could identify relevant prognostic implications of WRF in the very acute phase of AHF. Methods and results Data on 907 consecutive hospitalized patients with AHF in the REALITY-AHF study (age: 78±12 years; 55.1% male) were analyzed. Creatinine and BNP were measured at baseline and 48 hours from admission. WRF was defined as an increase in creatinine >0.3 mg at 48 hours from admission. The primary endpoint was 1-year all-cause mortality. Patients were divided into four groups according to the presence/absence of WRF and a BNP reduction higher/lower than the median: no-WRF/higher-BNP-reduction (n = 390), no-WRF/lower-BNP-reduction (n = 397), WRF/higher-BNP-reduction (n = 63), and WRF/lower-BNP-reduction groups (n = 57). Kaplan-Meier curve analysis showed that the WRF/lower-BNP-reduction

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Effect of Optimizing Guideline-Directed Medical Therapy Before Discharge on Mortality and Heart Failure Readmission in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

Cited by 48 publications

References 24 publications

Physicians' guideline adherence is associated with long‐term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry

Physicians' guideline adherence is associated with long‐term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry

GDMT for heart failure and the clinician's conundrum

Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure

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