Heart failure & cardiomyopathies
Withdrawal of Guideline-Directed Medical Therapy in Patients With Heart Failure and Improved Ejection Fraction
Authors' conclusion
In patients with HF with improved EF, HF therapy withdrawal was rare. Withdrawing RASi/ARNi and MRA was associated with higher mortality/morbidity at 1 year. No association was found for BBL withdrawal, albeit with a significant heterogeneity for EF at improvement, suggesting better outcomes with continuing BBL only until EF improves up to 50%.
Study context
- Population
- Patients with heart failure (HF) and improved ejection fraction (EF) (first EF <40%, later EF ≥40%), Swedish HF registry, 2000–2023
- Participants
- 8,728 patients
- Exposure
- Withdrawal vs continuation of GDMT
Methodological detailsregistry-based, overlap weighting
- Registry-based
- Overlap weighting
Main finding
As reported in the abstract
Renin-angiotensin inhibitors (RASi)/angiotensin receptor-neprilysin inhibitors (ARNi) withdrawal: higher risk
38%
Mineralocorticoid receptor antagonists (MRA) withdrawal: higher risk
36%
Observational data: associations, not effects.
Further findings
Withdrawal rates at improved EF registration
- RASi/ARNi
- 4.4%
- Beta-blockers (BBL)
- 3.3%
- MRA
- 17.2%
BBL withdrawal, by improved EF 40% to 49% vs ≥50% (subgroup)
- Higher risk of the primary outcome with BBL withdrawal in improved EF 40% to 49%
- Interaction P 0.03
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Summarised from the published abstract; every number is checked against it