Prognostic effect of guideline-directed therapy is more noticeable early in the course of heart failure

Min Soo Ahn, Byung Su Yoo, Junghan Yoon, Seung Hwan Lee, Jang Young Kim, Sung Gyun Ahn, Young Jin Youn, Jun Won Lee, Jung Woo Son, Hye Sim Kim, Dae Ryong Kang, Sang Eun Lee, Hyun Jai Cho, Hae Young Lee, Eun Seok Jeon, Seok Min Kang, Dong Ju Choi, Myeong Chan Cho

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. Methods: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. Results: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34-0.95), mortality (HR, 0.41; 95% CI, 0.24-0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36-0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41-0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47-0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. Conclusion: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.

Original languageEnglish
Article numbere133
JournalJournal of Korean medical science
Volume34
Issue number17
DOIs
Publication statusPublished - 2019 May 1

Fingerprint

Heart Failure
Guidelines
Confidence Intervals
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Guideline Adherence
Therapeutics
Hospitalization
Mineralocorticoid Receptor Antagonists
Mortality
Registries

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Ahn, Min Soo ; Yoo, Byung Su ; Yoon, Junghan ; Lee, Seung Hwan ; Kim, Jang Young ; Ahn, Sung Gyun ; Youn, Young Jin ; Lee, Jun Won ; Son, Jung Woo ; Kim, Hye Sim ; Kang, Dae Ryong ; Lee, Sang Eun ; Cho, Hyun Jai ; Lee, Hae Young ; Jeon, Eun Seok ; Kang, Seok Min ; Choi, Dong Ju ; Cho, Myeong Chan. / Prognostic effect of guideline-directed therapy is more noticeable early in the course of heart failure. In: Journal of Korean medical science. 2019 ; Vol. 34, No. 17.
@article{2784c3b6b52348c7a88aeee5a7da2a54,
title = "Prognostic effect of guideline-directed therapy is more noticeable early in the course of heart failure",
abstract = "Background: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. Methods: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. Results: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95{\%} confidence interval [CI], 0.34-0.95), mortality (HR, 0.41; 95{\%} CI, 0.24-0.69) and composite endpoint (HR, 0.52; 95{\%} CI, 0.36-0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95{\%} CI, 0.41-0.95) and composite endpoint (HR, 0.65; 95{\%} CI, 0.47-0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. Conclusion: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.",
author = "Ahn, {Min Soo} and Yoo, {Byung Su} and Junghan Yoon and Lee, {Seung Hwan} and Kim, {Jang Young} and Ahn, {Sung Gyun} and Youn, {Young Jin} and Lee, {Jun Won} and Son, {Jung Woo} and Kim, {Hye Sim} and Kang, {Dae Ryong} and Lee, {Sang Eun} and Cho, {Hyun Jai} and Lee, {Hae Young} and Jeon, {Eun Seok} and Kang, {Seok Min} and Choi, {Dong Ju} and Cho, {Myeong Chan}",
year = "2019",
month = "5",
day = "1",
doi = "10.3346/jkms.2019.34.e133",
language = "English",
volume = "34",
journal = "Journal of Korean Medical Science",
issn = "1011-8934",
publisher = "Korean Academy of Medical Science",
number = "17",

}

Prognostic effect of guideline-directed therapy is more noticeable early in the course of heart failure. / Ahn, Min Soo; Yoo, Byung Su; Yoon, Junghan; Lee, Seung Hwan; Kim, Jang Young; Ahn, Sung Gyun; Youn, Young Jin; Lee, Jun Won; Son, Jung Woo; Kim, Hye Sim; Kang, Dae Ryong; Lee, Sang Eun; Cho, Hyun Jai; Lee, Hae Young; Jeon, Eun Seok; Kang, Seok Min; Choi, Dong Ju; Cho, Myeong Chan.

In: Journal of Korean medical science, Vol. 34, No. 17, e133, 01.05.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognostic effect of guideline-directed therapy is more noticeable early in the course of heart failure

AU - Ahn, Min Soo

AU - Yoo, Byung Su

AU - Yoon, Junghan

AU - Lee, Seung Hwan

AU - Kim, Jang Young

AU - Ahn, Sung Gyun

AU - Youn, Young Jin

AU - Lee, Jun Won

AU - Son, Jung Woo

AU - Kim, Hye Sim

AU - Kang, Dae Ryong

AU - Lee, Sang Eun

AU - Cho, Hyun Jai

AU - Lee, Hae Young

AU - Jeon, Eun Seok

AU - Kang, Seok Min

AU - Choi, Dong Ju

AU - Cho, Myeong Chan

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. Methods: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. Results: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34-0.95), mortality (HR, 0.41; 95% CI, 0.24-0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36-0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41-0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47-0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. Conclusion: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.

AB - Background: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. Methods: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. Results: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34-0.95), mortality (HR, 0.41; 95% CI, 0.24-0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36-0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41-0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47-0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. Conclusion: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.

UR - http://www.scopus.com/inward/record.url?scp=85065576285&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065576285&partnerID=8YFLogxK

U2 - 10.3346/jkms.2019.34.e133

DO - 10.3346/jkms.2019.34.e133

M3 - Article

C2 - 31050223

AN - SCOPUS:85065576285

VL - 34

JO - Journal of Korean Medical Science

JF - Journal of Korean Medical Science

SN - 1011-8934

IS - 17

M1 - e133

ER -