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. 2021 Dec:94:73-84.
doi: 10.1016/j.ejim.2021.07.013. Epub 2021 Aug 24.

Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation

Josep Tost  1 , Pere Llorens  2 , Gad Cotter  3 , Beth Davison  3 , Javier Jacob  4 , Víctor Gil  5 , Pablo Herrero  6 , Francisco Javier Martín-Sánchez  7 , Ruxandra Donea  1 , Beatriz Rodríguez  8 , Francisco Javier Lucas-Imbernon  9 , Juan Antonio Andueza  10 , Ana Belén Mecina  11 , Raquel Torres-Gárate  12 , Pascual Piñera  13 , Aitor Alquézar-Arbé  14 , Begoña Espinosa  2 , Alexandre Mebazaa  15 , Ovidiu Chioncel  16 , Òscar Miró  17 ; ICA-SEMES group
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Free article

Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation

Josep Tost et al. Eur J Intern Med. 2021 Dec.
Free article

Abstract

Aims: To analyze the frequency with which patients with heart failure with preserved ejection fraction (HFpEF) discharged after an acute heart failure (AHF) episode are treated with antineurohormonal drugs (ANHD), the variables related to ANHD prescription and their relationship with outcomes.

Methods: We included consecutive HFpEF patients (left ventricular ejection fraction ≥50%) discharged after an AHF episode from 45 Spanish hospitals whose chronic medications and treatment at discharge were available. Patients were classified according to whether they were discharged with or without ANHD, including beta-blockers (BB), renin-angiotensin-aldosterone-system inhibitors (RAASi) and mineralcorticosteroid-receptor antagonists (MRA). Co-primary outcomes consisted of 1-year all-cause mortality and 90-day combined adverse event (revisit to emergency department -ED-, hospitalization due to AHF or all-cause death). Secondary outcomes were 90-day adverse events taken individually. Adjusted associations of ANHD treatment with outcomes were calculated.

Results: We analyzed 3,305 patients with HFpEF (median age: 83, 60% women), 2,312 (70%) discharged with ANHD. The ANHD most frequently prescribed was BB (45.8%). The 1-year mortality was 26.9% (adjusted HR for ANHD patients:1.17, 95%CI=0.98-1.38) and the 90-day combined adverse event was 54.4% (HR=1.14, 95%CI=0.99-1.31). ED revisit was significantly increased by ANHD (HR=1.15, 95%CI=1.01-1.32). MRA and BB were associated with worse results in some co-primary or secondary endpoints, while RAASi (alone) reduced 90-day hospitalization (HR=0.73, 98%CI=0.56-0.96).

Conclusion: 70% of HFpEF patients are discharged with ANHD after an AHF episode. ANHD do not seem to reduce mortality or adverse events in HFpEF patients, only RAASi could provide some benefits, reducing the risk of hospitalization for AHF.

Keywords: Acute heart failure; Antineurohormonal drugs; Emergency departments; Preserved ejection fraction; Prognosis.

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