Abstract | BACKGROUND: Clinical practice guidelines support sustained use of renin-angiotensin-aldosterone-system (RAAS) inhibitors over time in heart failure with reduced ejection fraction, yet few data are available regarding the frequency, timing or predictors of early treatment discontinuation in clinical practice. METHODS: RESULTS: Over median follow-up of 18 months, frequency of drug discontinuation of ACEis/ARBs, ARNIs and MRAs was 12.7% (444 of 3509 users), 10.4% (140 of 1352 users), and 20.4% (435 of 2129 users), respectively. An additional, 149 (11.0%) of ARNI users were switched to ACEis/ARBs, and 447 (12.7%) of ACEi/ARB users were switched to ARNIs during follow-up. Across sites, the median proportion of discontinuation of ACEis/ARBs, ARNIs and MRAs was 12.5% (25th-75th percentiles 6.9%-18.9%), 18.8% (25th-75th percentiles 12.5%-28.6%), and 19.6% (25th-75th percentiles 10.7%-27.0%), respectively. Chronic kidney disease was the only independent predictor of increased risk of discontinuation of each of the RAAS inhibitor classes (P < 0.02 for all). Higher Kansas City Cardiomyopathy Questionnaire overall summary scores independently predicted lower risk of discontinuation of ACEis/ARBs and ARNIs (both P < 0.001) but not of MRAs. Investigator clinical experience was predictive of lower risks of discontinuation of ACEis/ARBs and MRAs (P < 0.02) but not of ARNIs. All other independent predictors of discontinuation were unique to individual therapeutic classes. CONCLUSIONS: One in 10 patients discontinue ACEis/ARBs or ARNIs, and 1 in 5 discontinue MRAs in routine clinical practice of heart failure with reduced ejection fraction. Unique patient-level and clinician/practice-level factors are associated with premature discontinuation of individual RAAS inhibitors, which may help to guide structured efforts to promote treatment persistence in clinical care.
|
Authors | Muthiah Vaduganathan, Gregg C Fonarow, Stephen J Greene, Adam D Devore, Nancy M Albert, Carol I Duffy, C Larry Hill, J Herbert Patterson, John A Spertus, Laine E Thomas, Fredonia B Williams, Adrian F Hernandez, Javed Butler |
Journal | Journal of cardiac failure
(J Card Fail)
Vol. 28
Issue 2
Pg. 191-201
(02 2022)
ISSN: 1532-8414 [Electronic] United States |
PMID | 34428591
(Publication Type: Journal Article)
|
Copyright | Copyright © 2021 Elsevier Inc. All rights reserved. |
Chemical References |
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors
- Angiotensins
- Aldosterone
- Renin
|
Topics |
- Aldosterone
(pharmacology, therapeutic use)
- Angiotensin Receptor Antagonists
(pharmacology)
- Angiotensin-Converting Enzyme Inhibitors
(pharmacology)
- Angiotensins
(pharmacology, therapeutic use)
- Heart Failure
(diagnosis, drug therapy, epidemiology)
- Humans
- Renin
(pharmacology, therapeutic use)
- Renin-Angiotensin System
- Stroke Volume
|