Optimizing medical therapy before discharge reduces mortality in heart failure
Optimization of guideline-directed medical therapy (GDMT) for heart failure significantly reduces 1-year mortality, according to a subgroup analysis of the prospective observational REALITY-AHF study. [Yamaguchi T, AHA 2017, poster S3226]
Among 534 patients with heart failure with reduced ejection fraction (HFrEF), 332 were on angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) plus beta-blockers (BBs) at discharge, while 169 were on either ACEIs/ARBs or BBs. Thirty-three patients were on neither ACEIs/ARBs nor BBs and served as controls in the study.
Compared with the control group, patients on both ACEIs/ARBs and BBs had a 75 percent reduction in risk of mortality at 1 year (p<0.001), while those on either ACEIs/ARBs or BBs had a risk reduction of 58 percent (p=0.016). The risk reduction was 63 percent for patients on ACEIs/ARBs alone (p=0.031), and 55 percent for those on BBs alone (p=0.035).
However, readmission for heart failure at 1 year was not significantly reduced in patients on both ACEIs/ARBs and BBs (hazard ratio [HR], 1.53; p=0.36) or those on either ACEIs/ARBs or BBs (HR, 1.51; p=0.37).
“The prospectively collected real-world data showed that optimization of GDMT before discharge was significantly associated with lower 1-year mortality, and that introduction of ACEIs/ARBs or BBs was associated with better prognosis,” the authors concluded. “There was no significant association between GDMT at discharge and readmission for heart failure when death was accounted for as a competing risk.”