IMPACT OF INTENSIVE PHARMACOTHERAPY ON ISCHEMIC HEART FAILURE OUTCOMES
CCC ePoster Gallery. Crosier R. 10/26/19; 280522; 287
Dr. Rebecca Crosier
Dr. Rebecca Crosier
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Abstract
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BACKGROUND: Ischemic heart disease (IHD) is a frequent cause of heart failure (HF). The effectiveness of intensive, guideline-directed medical therapy (GDMTs) for HF and IHD on death and repeat hospitalization in a contemporary, acutely decompensated IHD HF population remains uncertain.

METHODS AND RESULTS: We examined the composite outcome of 1-year all-cause mortality or cardiovascular (CV) hospitalizations in 1873 patients admitted to over 50 different Ontario hospitals between April 1st, 2010, and March 31st, 2013, with acutely decompensated HF and IHD. We performed a multivariable Cox proportional hazards analysis comparing those prescribed 0-1, 2-3 or 4 GDMTs recommended for ischemic heart disease, including ACEi/ARBs, beta-blockers, statins, or antiplatelet agents upon hospital discharge. We used inverse probability of treatment weighting using the propensity score to compare outcomes between groups prescribed 0-1, 2-3 or 4 GDMTs. As we found a violation of the proportional hazards assumption, the follow-up period was divided into two periods: 0-180 days and 181-365 days. RESULTS: At time of index discharge, 467 patients were prescribed 0-1 drugs, 705 were prescribed 2-3 drugs and 701 were prescribed all 4 GDMTs upon hospital discharge. There were 275, 359, and 327 composite events (all-cause death or CV hospitalization) in those taking 0-1, 2-3, and 4 drugs up to one-year follow-up (Figure 1). The composite outcome occurred in 58.9%, 50.9%, and 46.7% of patients prescribed 0-1, 2-3, and 4 drugs, respectively. Adjusted hazard ratios (HRs) for all-cause death or CV hospitalization indicated a lower rate of the composite outcome over 0-180 days as the number of GDMTs increased: 0.74 (95% CI 0.62, 0.89) for the 2-3 drug group and 0.73 (95%CI 0.61, 0.88) for 4 drugs compared to 0-1 drugs. After propensity-weighting, the rates of all-cause death or CV hospitalizations were reduced, with HRs of 0.71 (95%CI; 0.59, 0.86) for 2-3 drugs and 0.66 (95%CI; 0.54, 0.80) for 4 drugs over 0-180 days (Table 1). No significant differences were observed over 181-365 days.

CONCLUSION: Patients with acutely decompensated ischemic HF are often discharged on sub-optimal medical therapy. Optimizing the use of guideline-directed anti-ischemic medications can be associated with reduced all-cause death or CV hospitalizations early after discharge from an acute HF admission.
BACKGROUND: Ischemic heart disease (IHD) is a frequent cause of heart failure (HF). The effectiveness of intensive, guideline-directed medical therapy (GDMTs) for HF and IHD on death and repeat hospitalization in a contemporary, acutely decompensated IHD HF population remains uncertain.

METHODS AND RESULTS: We examined the composite outcome of 1-year all-cause mortality or cardiovascular (CV) hospitalizations in 1873 patients admitted to over 50 different Ontario hospitals between April 1st, 2010, and March 31st, 2013, with acutely decompensated HF and IHD. We performed a multivariable Cox proportional hazards analysis comparing those prescribed 0-1, 2-3 or 4 GDMTs recommended for ischemic heart disease, including ACEi/ARBs, beta-blockers, statins, or antiplatelet agents upon hospital discharge. We used inverse probability of treatment weighting using the propensity score to compare outcomes between groups prescribed 0-1, 2-3 or 4 GDMTs. As we found a violation of the proportional hazards assumption, the follow-up period was divided into two periods: 0-180 days and 181-365 days. RESULTS: At time of index discharge, 467 patients were prescribed 0-1 drugs, 705 were prescribed 2-3 drugs and 701 were prescribed all 4 GDMTs upon hospital discharge. There were 275, 359, and 327 composite events (all-cause death or CV hospitalization) in those taking 0-1, 2-3, and 4 drugs up to one-year follow-up (Figure 1). The composite outcome occurred in 58.9%, 50.9%, and 46.7% of patients prescribed 0-1, 2-3, and 4 drugs, respectively. Adjusted hazard ratios (HRs) for all-cause death or CV hospitalization indicated a lower rate of the composite outcome over 0-180 days as the number of GDMTs increased: 0.74 (95% CI 0.62, 0.89) for the 2-3 drug group and 0.73 (95%CI 0.61, 0.88) for 4 drugs compared to 0-1 drugs. After propensity-weighting, the rates of all-cause death or CV hospitalizations were reduced, with HRs of 0.71 (95%CI; 0.59, 0.86) for 2-3 drugs and 0.66 (95%CI; 0.54, 0.80) for 4 drugs over 0-180 days (Table 1). No significant differences were observed over 181-365 days.

CONCLUSION: Patients with acutely decompensated ischemic HF are often discharged on sub-optimal medical therapy. Optimizing the use of guideline-directed anti-ischemic medications can be associated with reduced all-cause death or CV hospitalizations early after discharge from an acute HF admission.
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