Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study

W. Ouwerkerk; A. A. Voors; S. D. Anker; J. G. Cleland; K. Dickstein; G. Filippatos; P. van der Harst; H. L. Hillege; C. C. Lang; J. M. ter Maaten; L. L. Ng; P. Ponikowski; N. J. Samani; D. J. van Veldhuisen; F. Zannad; M. Metra; A. H. Zwinderman

doi:https://doi.org/10.1093/eurheartj/ehx026

Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study

W. Ouwerkerk, A. A. Voors, S. D. Anker, J. G. Cleland, K. Dickstein, G. Filippatos, P. van der Harst, H. L. Hillege, C. C. Lang, J. M. ter Maaten, L. L. Ng, P. Ponikowski, N. J. Samani, D. J. van Veldhuisen, F. Zannad, M. Metra, A. H. Zwinderman

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Abstract

Introduction Despite clear guidelines recommendations, most patients with heart failure and reduced ejection-fraction (HFrEF) do not attain guideline-recommended target doses. We aimed to investigate characteristics and for treatment-indication-bias corrected clinical outcome of patients with HFrEF that did not reach recommended treatment doses of ACE-inhibitors/Angiotensin receptor blockers (ARBs) and/or beta-blockers. Methods and results BIOSTAT-CHF was specifically designed to study uptitration of ACE-inhibitors/ARBs and/or beta-blockers in 2516 heart failure patients from 69 centres in 11 European countries who were selected if they were suboptimally treated while initiation or uptitration was anticipated and encouraged. Patients who died during the uptitration period (n=151) and patients with a LVEF > 40% (n = 242) were excluded. Median follow up was 21 months. We studied 2100 HFrEF patients (76% male; mean age 68 +/- 12), of which 22% achieved the recommended treatment dose for ACE-inhibitor/ARB and 12% of beta-blocker. There were marked differences between European countries. Reaching <50% of the recommended ACE-inhibitor/ARB and beta-blocker dose was associated with an increased risk of death and/or heart failure hospitalization. Patients reaching 50-99% of the recommended ACE-inhibitor/ARB and/or beta-blocker dose had comparable risk of death and/or heart failure hospitalization to those reaching >= 100%. Patients not reaching recommended dose because of symptoms, side effects and non-cardiac organ dysfunction had the highest mortality rate (for ACE-inhibitor/ARB: HR 1.72; 95% CI 1.43-2.01; for beta-blocker: HR 1.70; 95% CI 1.36-2.05). Conclusion Patients with HFrEF who were treated with less than 50% of recommended dose of ACE-inhibitors/ARBs and beta-blockers seemed to have a greater risk of death and/or heart failure hospitalization compared with patients reaching >= 100%

Original language	English
Pages (from-to)	1883-1890B
Journal	European Heart journal
Volume	38
Issue number	24
Early online date	2017
DOIs	https://doi.org/10.1093/eurheartj/ehx026
Publication status	Published - 2017

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Ouwerkerk, W., Voors, A. A., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., van der Harst, P., Hillege, H. L., Lang, C. C., ter Maaten, J. M., Ng, L. L., Ponikowski, P., Samani, N. J., van Veldhuisen, D. J., Zannad, F., Metra, M., & Zwinderman, A. H. (2017). Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study. European Heart journal, 38(24), 1883-1890B. https://doi.org/10.1093/eurheartj/ehx026

@article{81b78277eba64c8abfb29b7743c009bb,

title = "Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study",

abstract = "Introduction Despite clear guidelines recommendations, most patients with heart failure and reduced ejection-fraction (HFrEF) do not attain guideline-recommended target doses. We aimed to investigate characteristics and for treatment-indication-bias corrected clinical outcome of patients with HFrEF that did not reach recommended treatment doses of ACE-inhibitors/Angiotensin receptor blockers (ARBs) and/or beta-blockers. Methods and results BIOSTAT-CHF was specifically designed to study uptitration of ACE-inhibitors/ARBs and/or beta-blockers in 2516 heart failure patients from 69 centres in 11 European countries who were selected if they were suboptimally treated while initiation or uptitration was anticipated and encouraged. Patients who died during the uptitration period (n=151) and patients with a LVEF > 40% (n = 242) were excluded. Median follow up was 21 months. We studied 2100 HFrEF patients (76% male; mean age 68 +/- 12), of which 22% achieved the recommended treatment dose for ACE-inhibitor/ARB and 12% of beta-blocker. There were marked differences between European countries. Reaching <50% of the recommended ACE-inhibitor/ARB and beta-blocker dose was associated with an increased risk of death and/or heart failure hospitalization. Patients reaching 50-99% of the recommended ACE-inhibitor/ARB and/or beta-blocker dose had comparable risk of death and/or heart failure hospitalization to those reaching >= 100%. Patients not reaching recommended dose because of symptoms, side effects and non-cardiac organ dysfunction had the highest mortality rate (for ACE-inhibitor/ARB: HR 1.72; 95% CI 1.43-2.01; for beta-blocker: HR 1.70; 95% CI 1.36-2.05). Conclusion Patients with HFrEF who were treated with less than 50% of recommended dose of ACE-inhibitors/ARBs and beta-blockers seemed to have a greater risk of death and/or heart failure hospitalization compared with patients reaching >= 100%",

author = "W. Ouwerkerk and Voors, {A. A.} and Anker, {S. D.} and Cleland, {J. G.} and K. Dickstein and G. Filippatos and {van der Harst}, P. and Hillege, {H. L.} and Lang, {C. C.} and {ter Maaten}, {J. M.} and Ng, {L. L.} and P. Ponikowski and Samani, {N. J.} and {van Veldhuisen}, {D. J.} and F. Zannad and M. Metra and Zwinderman, {A. H.}",

year = "2017",

doi = "https://doi.org/10.1093/eurheartj/ehx026",

language = "English",

volume = "38",

pages = "1883--1890B",

journal = "European Heart journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "24",

}

Ouwerkerk, W, Voors, AA, Anker, SD, Cleland, JG, Dickstein, K, Filippatos, G, van der Harst, P, Hillege, HL, Lang, CC, ter Maaten, JM, Ng, LL, Ponikowski, P, Samani, NJ, van Veldhuisen, DJ, Zannad, F, Metra, M & Zwinderman, AH 2017, 'Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study', European Heart journal, vol. 38, no. 24, pp. 1883-1890B. https://doi.org/10.1093/eurheartj/ehx026

TY - JOUR

T1 - Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study

AU - Ouwerkerk, W.

AU - Voors, A. A.

AU - Anker, S. D.

AU - Cleland, J. G.

AU - Dickstein, K.

AU - Filippatos, G.

AU - van der Harst, P.

AU - Hillege, H. L.

AU - Lang, C. C.

AU - ter Maaten, J. M.

AU - Ng, L. L.

AU - Ponikowski, P.

AU - Samani, N. J.

AU - van Veldhuisen, D. J.

AU - Zannad, F.

AU - Metra, M.

AU - Zwinderman, A. H.

PY - 2017

Y1 - 2017

N2 - Introduction Despite clear guidelines recommendations, most patients with heart failure and reduced ejection-fraction (HFrEF) do not attain guideline-recommended target doses. We aimed to investigate characteristics and for treatment-indication-bias corrected clinical outcome of patients with HFrEF that did not reach recommended treatment doses of ACE-inhibitors/Angiotensin receptor blockers (ARBs) and/or beta-blockers. Methods and results BIOSTAT-CHF was specifically designed to study uptitration of ACE-inhibitors/ARBs and/or beta-blockers in 2516 heart failure patients from 69 centres in 11 European countries who were selected if they were suboptimally treated while initiation or uptitration was anticipated and encouraged. Patients who died during the uptitration period (n=151) and patients with a LVEF > 40% (n = 242) were excluded. Median follow up was 21 months. We studied 2100 HFrEF patients (76% male; mean age 68 +/- 12), of which 22% achieved the recommended treatment dose for ACE-inhibitor/ARB and 12% of beta-blocker. There were marked differences between European countries. Reaching <50% of the recommended ACE-inhibitor/ARB and beta-blocker dose was associated with an increased risk of death and/or heart failure hospitalization. Patients reaching 50-99% of the recommended ACE-inhibitor/ARB and/or beta-blocker dose had comparable risk of death and/or heart failure hospitalization to those reaching >= 100%. Patients not reaching recommended dose because of symptoms, side effects and non-cardiac organ dysfunction had the highest mortality rate (for ACE-inhibitor/ARB: HR 1.72; 95% CI 1.43-2.01; for beta-blocker: HR 1.70; 95% CI 1.36-2.05). Conclusion Patients with HFrEF who were treated with less than 50% of recommended dose of ACE-inhibitors/ARBs and beta-blockers seemed to have a greater risk of death and/or heart failure hospitalization compared with patients reaching >= 100%

AB - Introduction Despite clear guidelines recommendations, most patients with heart failure and reduced ejection-fraction (HFrEF) do not attain guideline-recommended target doses. We aimed to investigate characteristics and for treatment-indication-bias corrected clinical outcome of patients with HFrEF that did not reach recommended treatment doses of ACE-inhibitors/Angiotensin receptor blockers (ARBs) and/or beta-blockers. Methods and results BIOSTAT-CHF was specifically designed to study uptitration of ACE-inhibitors/ARBs and/or beta-blockers in 2516 heart failure patients from 69 centres in 11 European countries who were selected if they were suboptimally treated while initiation or uptitration was anticipated and encouraged. Patients who died during the uptitration period (n=151) and patients with a LVEF > 40% (n = 242) were excluded. Median follow up was 21 months. We studied 2100 HFrEF patients (76% male; mean age 68 +/- 12), of which 22% achieved the recommended treatment dose for ACE-inhibitor/ARB and 12% of beta-blocker. There were marked differences between European countries. Reaching <50% of the recommended ACE-inhibitor/ARB and beta-blocker dose was associated with an increased risk of death and/or heart failure hospitalization. Patients reaching 50-99% of the recommended ACE-inhibitor/ARB and/or beta-blocker dose had comparable risk of death and/or heart failure hospitalization to those reaching >= 100%. Patients not reaching recommended dose because of symptoms, side effects and non-cardiac organ dysfunction had the highest mortality rate (for ACE-inhibitor/ARB: HR 1.72; 95% CI 1.43-2.01; for beta-blocker: HR 1.70; 95% CI 1.36-2.05). Conclusion Patients with HFrEF who were treated with less than 50% of recommended dose of ACE-inhibitors/ARBs and beta-blockers seemed to have a greater risk of death and/or heart failure hospitalization compared with patients reaching >= 100%

U2 - https://doi.org/10.1093/eurheartj/ehx026

DO - https://doi.org/10.1093/eurheartj/ehx026

M3 - Article

C2 - 28329163

SN - 0195-668X

VL - 38

SP - 1883-1890B

JO - European Heart journal

JF - European Heart journal

IS - 24

ER -