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. 2023 Nov 17:10:1305824.
doi: 10.3389/fcvm.2023.1305824. eCollection 2023.

Impact of amlodipine on clinical outcomes for heart failure in patients with dilated cardiomyopathy: a Korean nationwide cohort study

SungA Bae #  1 , Wan Kee Kim #  2 , Seng Chan You  3 , Minkwan Kim  1 , In Hyun Jung  1
Affiliations

Impact of amlodipine on clinical outcomes for heart failure in patients with dilated cardiomyopathy: a Korean nationwide cohort study

SungA Bae et al. Front Cardiovasc Med. .

Abstract

Introduction: Amlodipine, widely used as a first-line treatment for hypertension, has inconclusive clinical evidence regarding its efficacy in patients with heart failure. This retrospective cohort study aimed to investigate the clinical effectiveness of amlodipine treatment after hospitalization for heart failure in patients with dilated cardiomyopathy (DCMP).

Methods: A total of 20,851 patients who were diagnosed with DCMP and admitted for heart failure between 2005 and 2016 according to Korean nationwide medical insurance service database were enrolled. Amlodipine use was defined as its prescription at the time of discharge and for at least 180 days within a year. The primary outcome was all-cause death, and the secondary outcome was heart failure rehospitalization during a 5-year period. The outcomes between patients who received amlodipine (n = 6,798) and those who did not (n = 14,053) were compared.

Results: During the 5-year follow-up, the group treated with amlodipine exhibited a significantly lower risk of all-cause death and heart failure rehospitalization than the group not treated with amlodipine [all-cause death: adjusted hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.59-0.70, p < 0.001; cardiovascular death: adjusted HR: 0.71, 95% CI: 0.62-0.81, p < 0.001; heart failure rehospitalization: adjusted HR: 0.92, 95% CI: 0.86-0.98, p = 0.006]. In a subgroup analysis, amlodipine had a significant impact on decreasing all-cause mortality in older adults, those with a higher systolic blood pressure, and those with a lower Charlson Comorbidity Index.

Conclusion: In summary, amlodipine use after hospitalization for heart failure in patients with DCMP was associated with a lower risk of all-cause death and readmission for heart failure.

Keywords: all-cause death; amlodipine; dilated cardiomyopathy; heart failure; hospitalization; hypertension; hypertension age; sex.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow. The data used in this study were obtained from the Korean national health insurance service cohort. CCB, calcium channel blocker; DCMP, dilated cardiomyopathy; HF, heart failure; MI, myocardial infarction; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Cumulative incidence of primary and secondary endpoints. Kaplan–Meier curves show the rates of (A) all-cause death, (B) cardiovascular death, (C) HF rehospitalization, and (D) composite of all-cause death or HF rehospitalization between amlodipine and no amlodipine use after HF in patients with DCMP. DCMP, dilated cardiomyopathy; HF, heart failure.
Figure 3
Figure 3
Exploratory subgroup analysis. CCI, Charlson comorbidity index; CI, confidence interval; CKD, chronic kidney disease; HR, hazard ratio; MR, mineralocorticoid receptor; RAAS, renin–angiotensin–aldosterone system; SBP, systolic blood pressure; VHD, valvular heart disease.
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