Variation in use and dosing escalation of renin angiotensin system, mineralocorticoid receptor antagonist, angiotensin receptor neprilysin inhibitor and beta-blocker therapies in heart failure and reduced ejection fraction: Association of comorbidities

Albert, Nancy; Tyson, Rachel; DeVore, Adam D.; Spertus, John A.; Duffy, Charles J.; Butler, Javed; Patterson, J. Herbert; Hernandez, Adrian F.; Williams, Fredonia B.; Thomas, Laine; Fonarow, Gregg C.

doi:10.1016/j.ahj.2021.01.017

Cited by 8 publications

(5 citation statements)

References 42 publications

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“…And, in HF with preserved ejection fraction (HFpEF), MRAs could be used for the control retention in patients with repeated hospitalization. Although, the positive associations between hydralazine and the risk of mortality in our study could be explained by the fact that those patients are older higher risk patients with multiple comorbidities 31 . In fact, among hydralazine users in our cohort, only 20% of them were using ACEIs or ARBs.…”

Section: Discussionmentioning

confidence: 57%

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Polypharmacy and risk of mortality among patients with heart failure following hospitalization: a nested case–control study

Perreault

Schnitzer

Eliane

et al. 2022

Sci Rep

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Heart failure (HF) is associated with morbidity, rehospitalization and polypharmacy. The incidence rate of mortality in HF patients with polypharmacy is poorly studied. We examine the association of polypharmacy with mortality risk in incident hospitalized HF patients with a primary diagnosis after discharge from the hospital using Quebec administrative databases, Canada from 1999 to 2015. Polypharmacy, cardiovascular (CV) polypharmacy and non-CV polypharmacy were respectively defined as exposure to ≥ 10 drugs, ≥ 5 CV drugs and ≥ 5 non-CV drugs within three months prior to the case or the control selection date. We conducted a nested case–control study to estimate rate ratios (RR) of all-cause mortality using a multivariate conditional logistic regression during one-year of follow-up. We identified 12,242 HF patients with a mean age of 81.6 years. Neither CV polypharmacy (RR 0.97, 95%CI 0.82–1.15) nor non-CV polypharmacy (RR 0.93, 95%CI 0.77–1.12) were associated with lower mortality risk. However, all polypharmacy (RR 1.31, 95%CI 1.07–1.61) showed an association with mortality risk. Myocardial infarction, valvular disease, peripheral artery disease, diabetes, major bleeding, chronic kidney disease, high comorbidity score, high Frailty score, hydralazine and spironolactone users were associated with increasing mortality risk, ranging from 15 to 61%, while use of angiotensin II inhibitors, beta-blockers, statins, anticoagulant, and antiplatelets were associated with lower risk, ranging from 23 to 32%.

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Section: Discussionmentioning

confidence: 57%

“…In fact, among hydralazine users in our cohort, only 20% of them were using ACEIs or ARBs. Conversely, the positive association between spironolactone and the risk of mortality is less intuitive, given that since the mean and median (interquartile range) dose of spironolactone used was 25 mg 31 , 32 .…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy and risk of mortality among patients with heart failure following hospitalization: a nested case–control study

Perreault

Schnitzer

Eliane

et al. 2022

Sci Rep

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“…The results of the current analysis are in line with numerous HF studies showing the clinical benefits of renin-angiotensinaldosterone system inhibition in diverse stages of kidney disease 18-21 or diabetic status. 22 Although asthma and COPD are associated with a lower likelihood of being prescribed a BB and being prescribed the target dose, 23 multiple studies and meta-analyses found that BBs improve survival in these patients without significant worsening of respiratory symptoms. [24][25][26][27] Also, robust evidence shows that BBs improved mortality and decreased all-cause hospitalization, regardless of diabetic status.…”

Section: Discussionmentioning

confidence: 99%

Non‐cardiac comorbidities and intensive up‐titration of oral treatment in patients recently hospitalized for heart failure: Insights from the STRONG‐HF trial

Chioncel,

Davison,

Adamo

et al. 2023

European J of Heart Fail

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AimsTo assess the potential interaction between noncardiac comorbidities (NCCs) and the efficacy and safety of high intensity care (HIC) versus usual care (UC) in STRONG‐HF trial, including stable patients with improved but still elevated NPsMethods and ResultsIn the trial, 8 NCCs were reported: anemia, diabetes, renal dysfunction, severe liver disease, COPD/asthma, stroke/TIA, psychiatric/neurological disorders, and malignancies. Patients were classified by NCC number (0, 1, 2 and ≥3). The treatment effect of HIC versus UC on the primary endpoint, 180‐day death or HF‐rehospitalization, was compared by NCC number and by each individual comorbidity.Among the 1078 patients, the prevalence of 0, 1, 2 and ≥3 NCCs was 24.3%, 39.8%, 24.5% and 11.3%. Achievement of full doses of HF‐therapies at 90‐ and 180‐days in the HIC was similar irrespective of NCCs number.In the HIC, the primary endpoint occurred in 10.0%, 16,6%, 13,6% and 26,2%, in those with 0, 1, 2 and ≥3 NCCs, as compared to 19,1%, 25,4%, 23,3% and 26,2% in UC (interaction‐p=0.80). The treatment benefit of HIC vs. UC on the primary endpoint didn't differ significantly by each individual comorbidity. There was no significant treatment interaction by NCC number in quality‐of‐life improvement (p=0.98) or the incidence of serious adverse events (p=0.11).ConclusionsIn the STRONG‐HF trial, non‐cardiac comorbidities neither limited the rapid up‐titration of HF‐therapies, nor attenuated the benefit of HIC on primary endpoint. In the context of a clinical trial, the benefit‐risk ratio favors the rapid up‐titration of HF‐therapies even in patients with multiple NCCsThis article is protected by copyright. All rights reserved.

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“…Notably, our findings align with contemporary cardiovascular treatment trends, as a significant portion of patients received ACEI and ARBs (81.6%), mineralocorticoid receptor antagonists (35.5%), and angiotensin receptor neprilysin inhibitors (47.9%). This reflects the adoption of evidence-based therapies [ 19 , 20 ]. Abnormal troponin and BNP levels are consistent with literature emphasizing the need for vigilant monitoring and management of cardiac and renal function in this patient group to optimize outcomes.…”

Section: Discussionmentioning

confidence: 99%

Association Between Cardiovascular Disease and Chronic Kidney Disease Prevalence and Characteristics in Saudi Arabia

Elheet,

Alosaimi,

Alalawi

et al. 2023

Cureus

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Introduction Cardiovascular disease (CVD), including coronary artery disease (CAD), is a leading global cause of death. Chronic kidney disease (CKD) is a significant risk factor, particularly in data-scarce Saudi Arabia, due to shared risk factors. A study aims to assess the CVD-CKD relationship, identifying clinical characteristics and risk factors to improve prevention and care in this context, filling a knowledge gap in Saudi Arabia's healthcare map. Methodology It is a single-center retrospective study aimed at evaluating the relationship between cardiovascular disease and chronic kidney disease, conducted between January 2023 and October 2023. Data was sourced from patient files using a data sheet based on a previous study. The data was cleaned in MS Excel (Redmond, USA) and analyzed in IBM Corp. Released 2022. IBM SPSS Statistics for Windows, Version 29.0. Armonk, NY: IBM Corp. Results Our study contains predominantly males (61%), aged 61-80 (54.1%), with a normal body mass index (BMI) (<25) (61.5%) and a high prevalence of smoking (72.3%). Diabetes, hypertension, and smoking were prevalent risk factors. The relationship between CAD severity, renal dysfunction, and ejection fraction (EF) was explored, emphasizing the association between declining renal function and more advanced CAD stages, as well as the decline in estimated glomerular filtration rate (eGFR) with decreasing EF. Age, smoking, CAD, and decreasing EF were linked to renal dysfunction, while smoking, stroke history, peripheral vascular disease (PVD), BMI, and decreasing EF were associated with CAD stage severity. Conclusion Our study explored that as CAD severity increases, renal function decreases, showing both CVD and CKD connected with each other, and a similar correlation occurs between decreasing EF and decreasing eGFR, revealing significant associations with various risk factors. Further research is warranted to explore potential interventions aimed at mitigating the synergistic impact of CVD and CKD on patient morbidity and mortality.

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Variation in use and dosing escalation of renin angiotensin system, mineralocorticoid receptor antagonist, angiotensin receptor neprilysin inhibitor and beta-blocker therapies in heart failure and reduced ejection fraction: Association of comorbidities

Cited by 8 publications

References 42 publications

Polypharmacy and risk of mortality among patients with heart failure following hospitalization: a nested case–control study

Polypharmacy and risk of mortality among patients with heart failure following hospitalization: a nested case–control study

Non‐cardiac comorbidities and intensive up‐titration of oral treatment in patients recently hospitalized for heart failure: Insights from the STRONG‐HF trial

Association Between Cardiovascular Disease and Chronic Kidney Disease Prevalence and Characteristics in Saudi Arabia

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