Abstract
OBJECTIVE: Women with heart failure with reduced ejection fraction (HFrEF) may reach optimal treatment effect at half of the guideline-recommended medication dose. This study investigates prescription practice and its relation with survival of patients with HF in daily care.
METHODS: Electronic health record data from 13 Dutch outpatient cardiology clinics were extracted for HF receiving at least one guideline-recommended HF medication. Dose changes over consecutive prescriptions were modelled using natural cubic splines. Inverse probability-weighted Cox regression was used to assess the relationship between dose (reference≥50% target dose) and all-cause mortality.
RESULTS: The study population comprised 561 women (29% HFrEF (ejection fraction (EF)<40%), 49% heart failure with preserved ejection fraction (EF≥50%); HFpEF and 615 men (47% and 25%, respectively). During a median follow-up of 3.7 years, 252 patients died (48% women; 167 HFrEF, 84 HFpEF). Nine hundred thirty-four patients (46% women) received ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 795 (48% women) beta blockers and 178 (42% women) mineralocorticoid receptor antagonists (MRAs). In both sexes, the mean target dose across prescriptions was 50% for ACEI/ARBs and beta blockers, and 100% for MRAs. ACEI/ARB dose of <50% was associated with lower mortality in women but not in men with HFrEF. This was not seen in patients with HFpEF. Beta-blocker dose was not associated with all-cause mortality.
CONCLUSION: Patients with HF seen in outpatient cardiology clinics receive half of the guideline-recommended medication dose. Lower ACEI/ARB dose was associated with improved survival in women with HFrEF. These results underscore the importance of (re)defining optimal medical therapy for women with HFrEF.
Original language | English |
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Pages (from-to) | 1748-1755 |
Number of pages | 8 |
Journal | Heart (British Cardiac Society) |
Volume | 107 |
Issue number | 21 |
DOIs | |
Publication status | Published - Nov 2021 |
Keywords
- Adrenergic beta-Antagonists/administration & dosage
- Aged
- Ambulatory Care Facilities/statistics & numerical data
- Angiotensin Receptor Antagonists/administration & dosage
- Angiotensin-Converting Enzyme Inhibitors/administration & dosage
- Cause of Death/trends
- Dose-Response Relationship, Drug
- Female
- Follow-Up Studies
- Guideline Adherence
- Heart Failure/drug therapy
- Heart Ventricles/diagnostic imaging
- Humans
- Male
- Mineralocorticoid Receptor Antagonists/administration & dosage
- Netherlands/epidemiology
- Registries
- Retrospective Studies
- Stroke Volume/physiology
- Survival Rate/trends
- Ventricular Function, Left/physiology