Heart failure & cardiomyopathies
Real-World Safety of Neurohormonal Antagonist Initiation Among Older Adults Following a Heart Failure Hospitalization
Authors' conclusion
Initiating 1-2 NHAs among older adults within 90 days of HFrEF hospitalization was associated with lower mortality and lower readmission. However, initiating 3 NHAs was not associated with reduced mortality or readmission and was associated with a significant risk for fall-related adverse events.
Study context
- Population
- Medicare beneficiaries discharged home after heart failure with reduced ejection fraction (HFrEF) hospitalization (2008–2015)
- Participants
- 207,223 beneficiaries
- Exposure
- Initiation of 1, 2 or 3 neurohormonal antagonists (NHAs) vs 0 within 90 days of discharge
- Outcome
- All-cause mortality, all-cause rehospitalization and fall-related adverse events
- Follow-up
- 90 days after hospitalization
Methodological detailsinverse probability-weighted, time-varying exposure
- Inverse probability-weighted
- Time-varying exposure
Main finding
As reported in the abstract
All-cause mortality · 90 days
Each group vs 0 NHAsIPW-HR (95% CI)
1 NHA
0.80(0.78–0.83)
2 NHAs
0.70(0.66–0.75)
3 NHAs
0.94(0.83–1.06)
Observational data: associations, not effects.
Further findings
| Outcome | IPW-HR (95% CI) | |
|---|---|---|
| All-cause readmission · 90 days1 NHAvs 0 NHAs | 0.95 (0.93–0.96) | |
| All-cause readmission · 90 days2 NHAsvs 0 NHAs | 0.89 (0.86–0.91) | |
| All-cause readmission · 90 days3 NHAsvs 0 NHAs | 0.96 (0.90–1.02) | |
| 0.512IPW-HR (log scale) |
Safety
| Outcome | IPW-HR (95% CI) | |
|---|---|---|
| Fall-related adverse events · 90 days1 NHAvs 0 NHAs | 1.13 (1.10–1.15) | |
| Fall-related adverse events · 90 days2 NHAsvs 0 NHAs | 1.25 (1.21–1.30) | |
| Fall-related adverse events · 90 days3 NHAsvs 0 NHAs | 1.64 (1.54–1.76) | |
| 0.512IPW-HR (log scale) |
Original publication
Real-World Safety of Neurohormonal Antagonist Initiation Among Older Adults Following a Heart Failure Hospitalization. ESC Heart Fail. Published 20 February 2023. doi:10.
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