Heart failure & cardiomyopathies
Titration of Medications and Outcomes in Multi-Ethnic Heart Failure Cohorts (with Reduced Ejection Fraction) from Singapore and New Zealand
Authors' conclusion
Although HF medication use at baseline was high, most patients did not have these medications up-titrated over 6 months. Multiple clinical factors were associated with changes in medication dosages.
Study context
- Population
- Multi-ethnic patients with HF with reduced ejection fraction (HFrEF) (LVEF <40%) from Singapore and New Zealand714 (64%) from Singapore
- Participants
- 1,110 patients
- Exposure
- Dose categories of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs) and beta-blockers vs Nil
- Outcome
- Titration patterns of ACEis/ARBs and beta-blockers; 1-year all-cause mortality/HF hospitalization
- Follow-up
- 6 months (titration); 1 year (outcome)
Methodological detailsmulticentre, inverse probability weighting
- Multicentre
- Inverse probability weighting
Main finding
As reported in the abstract
Titration patterns and 1-year composite outcome
Each group vs nilHazard ratio (95% CI)
≥100% GRD ACEis/ARBs
0.42(0.24–0.73)
≥50% GRD beta-blockers
0.58(0.37–0.90)
- Baseline use of ACEis/ARBs or beta-blockers
- 87%
- 100% GRD at baseline, ACEis/ARBs and beta-blockers respectively
- 11% and 9%
- ≥50% GRD at baseline for ACEis/ARBs or beta-blockers
- 47%
- Up-titrated at 6 months
- 10-16%
- Down-titrated at 6 months
- 4-6%
Observational data: associations, not effects.
Further findings
Predictors of titration
- Lower (vs higher) NT-proBNP more likely up-titrated or 'stay high'
- P = 0.002
- Ischaemic aetiology, prior HF hospitalization and enrolment in Singapore (vs New Zealand) associated with higher odds of 'staying low'
- all P < 0.005
- Country of enrolment did not modify associations of dose with 1-year composite outcome
Quality of life (QoL) · 6 months
- Higher medication doses associated with greater improvements in QoL
Original publication
Titration of Medications and Outcomes in Multi-Ethnic Heart Failure Cohorts (with Reduced Ejection Fraction) from Singapore and New Zealand. ESC Heart Fail. Published 1 February 2023. doi:10.
Summarised from the published abstract; every number is checked against it