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Heart failure pharmacological treatments and outcomes in heart failure with mildly reduced ejection fraction
BACKGROUND: Guideline recommendations for the treatment of heart failure with mildly reduced ejection fraction (HFmrEF) derive from small subgroups in post-hoc analyses of randomized trials. OBJECTIVES: We investigated predictors of renin–angiotensin system inhibitors/angiotensin receptor neprilysin...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10509568/ https://www.ncbi.nlm.nih.gov/pubmed/37204037 http://dx.doi.org/10.1093/ehjcvp/pvad036 |
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author | Stolfo, Davide Lund, Lars H Sinagra, Gianfranco Lindberg, Felix Dahlström, Ulf Rosano, Giuseppe Savarese, Gianluigi |
author_facet | Stolfo, Davide Lund, Lars H Sinagra, Gianfranco Lindberg, Felix Dahlström, Ulf Rosano, Giuseppe Savarese, Gianluigi |
author_sort | Stolfo, Davide |
collection | PubMed |
description | BACKGROUND: Guideline recommendations for the treatment of heart failure with mildly reduced ejection fraction (HFmrEF) derive from small subgroups in post-hoc analyses of randomized trials. OBJECTIVES: We investigated predictors of renin–angiotensin system inhibitors/angiotensin receptor neprilysin inhibitors (RASI/ARNI) and beta-blockers use, and the associations between these medications and mortality/morbidity in a large real-world cohort with HFmrEF. METHODS AND RESULTS: Patients with HFmrEF (EF 40–49%) from the Swedish HF Registry were included. The associations between medications and cardiovascular (CV) mortality/HF hospitalization (HFH), and all-cause mortality were assessed through Cox regressions in a 1:1 propensity score-matched cohort. A positive control analysis was performed in patients with EF < 40%, while a negative control outcome analysis had cancer-related hospitalization as endpoint. Of 12 421 patients with HFmrEF, 84% received RASI/ARNI and 88% beta-blockers. Shared-independent predictors of RASI/ARNI and beta-blockers use were younger age, being an outpatient, follow-up in specialty care, and hypertension. In the matched cohorts, use of both RASI/ARNI and beta-blocker use was separately associated with lower risk of CV mortality/HFH [hazard ratio (HR) = 0.90, 95% confidence interval (CI): 0.83–0.98 and HR = 0.82, 95% CI: 0.74–0.90, respectively] and of all-cause mortality (HR = 0.75, 95% CI: 0.69–0.81 and HR = 0.79, 95% CI: 0.72–0.87, respectively). Results were consistent at the positive control analysis, and there were no associations between treatment use and the negative control outcome. CONCLUSIONS: RASI/ARNI and beta-blockers were extensively used in this large real-world cohort with HFmrEF. Their use was safe since associated with lower mortality and morbidity. Our findings confirm the real-world evidence from previous post-hoc analyses of trials, and represent a further call for implementing guideline recommendations. |
format | Online Article Text |
id | pubmed-10509568 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-105095682023-09-21 Heart failure pharmacological treatments and outcomes in heart failure with mildly reduced ejection fraction Stolfo, Davide Lund, Lars H Sinagra, Gianfranco Lindberg, Felix Dahlström, Ulf Rosano, Giuseppe Savarese, Gianluigi Eur Heart J Cardiovasc Pharmacother Original Article BACKGROUND: Guideline recommendations for the treatment of heart failure with mildly reduced ejection fraction (HFmrEF) derive from small subgroups in post-hoc analyses of randomized trials. OBJECTIVES: We investigated predictors of renin–angiotensin system inhibitors/angiotensin receptor neprilysin inhibitors (RASI/ARNI) and beta-blockers use, and the associations between these medications and mortality/morbidity in a large real-world cohort with HFmrEF. METHODS AND RESULTS: Patients with HFmrEF (EF 40–49%) from the Swedish HF Registry were included. The associations between medications and cardiovascular (CV) mortality/HF hospitalization (HFH), and all-cause mortality were assessed through Cox regressions in a 1:1 propensity score-matched cohort. A positive control analysis was performed in patients with EF < 40%, while a negative control outcome analysis had cancer-related hospitalization as endpoint. Of 12 421 patients with HFmrEF, 84% received RASI/ARNI and 88% beta-blockers. Shared-independent predictors of RASI/ARNI and beta-blockers use were younger age, being an outpatient, follow-up in specialty care, and hypertension. In the matched cohorts, use of both RASI/ARNI and beta-blocker use was separately associated with lower risk of CV mortality/HFH [hazard ratio (HR) = 0.90, 95% confidence interval (CI): 0.83–0.98 and HR = 0.82, 95% CI: 0.74–0.90, respectively] and of all-cause mortality (HR = 0.75, 95% CI: 0.69–0.81 and HR = 0.79, 95% CI: 0.72–0.87, respectively). Results were consistent at the positive control analysis, and there were no associations between treatment use and the negative control outcome. CONCLUSIONS: RASI/ARNI and beta-blockers were extensively used in this large real-world cohort with HFmrEF. Their use was safe since associated with lower mortality and morbidity. Our findings confirm the real-world evidence from previous post-hoc analyses of trials, and represent a further call for implementing guideline recommendations. Oxford University Press 2023-05-18 /pmc/articles/PMC10509568/ /pubmed/37204037 http://dx.doi.org/10.1093/ehjcvp/pvad036 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Article Stolfo, Davide Lund, Lars H Sinagra, Gianfranco Lindberg, Felix Dahlström, Ulf Rosano, Giuseppe Savarese, Gianluigi Heart failure pharmacological treatments and outcomes in heart failure with mildly reduced ejection fraction |
title | Heart failure pharmacological treatments and outcomes in heart failure with mildly reduced ejection fraction |
title_full | Heart failure pharmacological treatments and outcomes in heart failure with mildly reduced ejection fraction |
title_fullStr | Heart failure pharmacological treatments and outcomes in heart failure with mildly reduced ejection fraction |
title_full_unstemmed | Heart failure pharmacological treatments and outcomes in heart failure with mildly reduced ejection fraction |
title_short | Heart failure pharmacological treatments and outcomes in heart failure with mildly reduced ejection fraction |
title_sort | heart failure pharmacological treatments and outcomes in heart failure with mildly reduced ejection fraction |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10509568/ https://www.ncbi.nlm.nih.gov/pubmed/37204037 http://dx.doi.org/10.1093/ehjcvp/pvad036 |
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