Abstract | BACKGROUND: For patients hospitalized for heart failure with reduced ejection fraction (HFrEF), guidelines recommend optimization of medical therapy prior to discharge. The degree to which changes in medical therapy occur during hospitalizations for HFrEF in North American clinical practice is unclear. METHODS: RESULTS: Of 1695 patients, the median (IQR) age was 69 (59-79) years, and 33% were women. Among eligible patients, 33%, 25% and 55% were not prescribed ACEI/ARB/ARNI, beta-blocker, and MRA at discharge, respectively; 99% were not prescribed SGLT2i. For each medication, > 50% of patients remained on stable subtarget doses or no medication during hospitalization. In-hospital rates of initiation/dose increase were 20% for ACEI/ARB, 4% for ARNI, 20% for beta-blocker, 22% for MRA, and < 1% for SGLT2i; corresponding rates of dose decrease/discontinuation were 11%, 2%, 9%, 5%, and < 1%, respectively. Overall, 17% and 28% of eligible patients were prescribed triple therapy prior to admission and at discharge, respectively. At both admission and discharge, 1% of patients were prescribed triple therapy at target doses. Across classes of medication, multiple factors were independently associated with higher likelihood of in-hospital initiation/dosing increase (eg, Canadian enrollment, white race, admission to intensive care units) and discontinuation/dosing decrease (eg, worse renal function, admission to intensive care units). CONCLUSIONS: In this contemporary North American registry of patients hospitalized for worsening chronic HFrEF, for each recommended medical therapy, the large majority of eligible patients remained on stable subtarget doses or without medication at admission and discharge. Although most patients had no alterations in medical therapy, hospitalization in Canada and multiple patient characteristics were associated with higher likelihood of favorable in-hospital medication changes.
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Authors | Stephen J Greene, Justin A Ezekowitz, Kevin J Anstrom, Vladimir Demyanenko, Michael M Givertz, Ileana L Piña, Christopher M O'Connor, Joerg Koglin, Lothar Roessig, Adrian F Hernandez, Paul W Armstrong, Robert J Mentz |
Journal | Journal of cardiac failure
(J Card Fail)
Vol. 28
Issue 7
Pg. 1063-1077
(07 2022)
ISSN: 1532-8414 [Electronic] United States |
PMID | 35301107
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2022 Elsevier Inc. All rights reserved. |
Chemical References |
- Adrenergic beta-Antagonists
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors
- Mineralocorticoid Receptor Antagonists
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Topics |
- Adrenergic beta-Antagonists
(therapeutic use)
- Aged
- Angiotensin Receptor Antagonists
(pharmacology)
- Angiotensin-Converting Enzyme Inhibitors
(pharmacology)
- Canada
- Female
- Heart Failure
(drug therapy, epidemiology)
- Hospitalization
- Humans
- Male
- Mineralocorticoid Receptor Antagonists
(therapeutic use)
- Registries
- Stroke Volume
(physiology)
- United States
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