Heart failure & cardiomyopathiesCohort study
Association Between a Hospitalization for Heart Failure and the Initiation/Discontinuation of Guideline-Recommended Treatments: An Analysis from the Swedish Heart Failure Registry
- Registry-based cohort study
Authors' conclusion
Following a HF hospitalization, initiation of GDMT was more likely than discontinuation, although still limited. Perceived or actual low tolerance were barriers to GDMT implementation. Early re-/initiation of GDMT was associated with better survival.
Study context
- Population
- Patients with EF <50% in the Swedish heart failure (HF) registry, enrolled 2009–2018
- Participants
- 14,737 patients
- Exposure
- HF hospitalization vs no HF hospitalization
- HF hospitalizationn = 6,893
- Outcome
- Initiation/discontinuation of GDMT (dispensations) and consequent outcomes
Main finding
As reported in the abstract
Initiation of GDMT, OR range for individual medications (vs control)
2.1-4.0
Discontinuation of GDMT, OR range for individual medications (vs control)
1.4-1.6
Proportion of patients not on GDMT still high
8.1-44.0%
Observational data: associations, not effects.
Further findings
Patient characteristics associated with less GDMT use
- Older age and worse renal function triggered less initiation or more discontinuation
Mortality after HF hospitalization by GDMT initiation/discontinuation
- Initiation of RAS inhibitors/ARNI or beta-blockers associated with lower, discontinuation with higher mortality risk
- No association with mortality for initiation/discontinuation of MRA
Original publication
Summarised from the published abstract; every number is checked against it