Association between class of foundational medication for heart failure and prognosis in heart failure with reduced/mildly reduced ejection fraction.
Association between class of foundational medication for heart failure and prognosis in heart failure with reduced/mildly reduced ejection fraction.
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DOI：
10.1038/s41598-022-20892-3
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发表时间：
2022-10-05
影响因子：
4.6
通讯作者：
中科院分区：
文献类型：
--
作者：
我们阐明了在心力衰竭(HF)恶化住院期间基础药物(FMHF)的数量变化与出院后预后之间的关系。我们回顾分析了日本三个大规模住院心力衰竭患者(NARA-HF、湿性心力衰竭和REAL-AHF)和入院前左室射血分数(HFR/mrEF)降低或轻度降低的心力衰竭患者的综合数据集。根据从入院到出院的FMHF处方类别的变化对患者进行分层：血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、β受体阻滞剂和盐皮质激素受体阻滞剂。主要终点是心衰再住院和出院一年内全因死亡的综合终点。队列包括1113名患者，观察到482个联合终点。总体来说，与入院时相比，出院时FMHF处方增加413例(37.1%)，保持不变607例(54.5%)，减少93例(8.4%)(减少组)。在多变量分析中，增加组的主要终点发生率显著低于未增加组(风险比0.56，95%可信区间0.45-0.60；P <； 0.001)。总之，在HF住院期间增加FMHF分级与HFR/mrEF患者的预后较好相关。
We clarified the association between changes in the number of foundational medications for heart failure (FMHF) during hospitalization for worsening heart failure (HF) and post-discharge prognosis. We retrospectively analyzed a combined dataset from three large-scale registries of hospitalized patients with HF in Japan (NARA-HF, WET-HF, and REALITY-AHF) and patients diagnosed with HF with reduced or mildly reduced left ventricular ejection fraction (HFr/mrEF) before admission. Patients were stratified by changes in the number of prescribed FMHF classes from admission to discharge: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor blockers. Primary endpoint was the combined endpoint of HF rehospitalization and all-cause death within 1 year of discharge. The cohort comprised 1113 patients, and 482 combined endpoints were observed. Overall, FMHF prescriptions increased in 413 (37.1%) patients (increased group), remained unchanged in 607 (54.5%) (unchanged group), and decreased in 93 (8.4%) (decreased group) at discharge compared with that during admission. In the multivariable analysis, the increased group had a significantly lower incidence of the primary endpoint than the unchanged group (hazard ratio 0.56, 95% confidence interval 0.45–0.60; P < 0.001). In conclusion, increase in FMHF classes during HF hospitalization is associated with a better prognosis in patients with HFr/mrEF.
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