Effects of calcium channel blockers on GDMT prescription and outcomes according to ejection fraction: IN-HF real world data

Abstract

Background: Dihydropyridine calcium channel blockers (DHP-CCB) are widely used in heart failure (HF), despite the lack of data regarding their safety, especially in patients with reduced ejection fraction (HFrEF). We aimed to evaluate DHP-CCB prescription trends over time, their association with GDMT uptake and related outcomes across the spectrum of EF.

Methods: We studied outpatients with chronic HF prospectively enrolled in the nationwide observational INHF registry from 1998 to 2022. We used Cox regression methods to analyze all-cause mortality and cardiovascular hospitalization at 1-year according to DHP-CCB exposure, applying inverse probability of treatment weighting (IPTW).

Results: We included 15785 outpatients. 10829 (69 %) had HFrEF, and 4956(31 %) an EF>40 %. Median age was 69; 26.6 % were females. Overall, 1458 patients (9.1 %) received a DHP-CCB. DHP-CCB administration was twice as prevalent in patients with an EF>40 % than in those with HFrEF (13.9 %¦vs 7.1 %, respectively p<0.001). DHP-CCB prescription rates increased over time (p<0.001). Patients who received DHP-CCB were older, more comorbid, had a higher EF, and were less frequently prescribed GDMT than those who were not on DHP-CCB. After multivariable adjustment, using IPTW analysis, DHP-CCB prescription was associated with a higher risk of the outcome in the overall cohort (HR 1.11, 95 % CI 1.09-1.12, p<0.001), among HFrEF patients (HR 1.14, 95 % CI 1.12-1.16, p<0.001), and those with EF>40 % (HR 1.07, 95 % CI 1.04-1.10, p<0.001).

Conclusion: DHP-CCB use in HFrEF was associated with less GDMT prescription and worse outcomes. Additionally, DHP-CCB safety needs to be further explored in HFmrEF/HFpEF.

Keywords: Calcium channel blocker; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction; Outcome.