Please use this identifier to cite or link to this item:
http://hdl.handle.net/1942/16186
Title: | Uptitration of Renin-Angiotensin System Blocker and Beta-Blocker Therapy in Patients Hospitalized for Heart Failure With Reduced Versus Preserved Left Ventricular Ejection Fractions | Authors: | VERBRUGGE, Frederik Duchenne, Juergen BERTRAND, Philippe DUPONT, Matthias Tang, W. H. Wilson MULLENS, Wilfried |
Issue Date: | 2013 | Source: | AMERICAN JOURNAL OF CARDIOLOGY, 112 (12), p. 1913-1920 | Abstract: | In ambulatory patients with heart failure (HF) and reduced ejection fraction (rEF), renin-angiotensin system (RAS) and beta-blockers at guideline-recommended target dose reduce all-cause mortality and readmissions. Benefits in HF with preserved ejection fraction (pEF), as well as uptitration after a hospitalization, remain uncertain. This study assesses the impact of RAS- and a-blocker uptitrations in patients with HFrEF versus HFpEF during and immediately after a hospital admission. In consecutive patients (209 HFrEF with left ventricular ejection fraction <40% and 108 HFpEF with left ventricular ejection fraction >= 40%), RAS- and beta-blocker dose changes were followed during 6 months after an index HF hospitalization. Patients with a RAS- and beta-blocker dose increase of 10% of the recommended target dose were compared with patients without uptitration. Patients who received uptitration were significantly younger, with a higher heart rate and better renal function, and received spironolactone more often. Both RAS- and beta-blocker uptitrations were associated with significant reductions in the composite end-point of all-cause mortality or HF readmissions in HFrEF (hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.22 to 0.60 and HR 0.51, 95% CI 0.32 to 0.81, respectively). After correction for age, heart rate, blood pressure, renal function, and spironolactone use, this association remained significant for RAS blockers (HR 0.54, 95% CI 0.31 to 0.93, p = 0.027) but not for beta-blockers (HR 0.65, 95% CI 0.39 to 1.09, p = 0.101). No benefit of RAS- or beta-blocker uptitration was observed in HFpEF. In conclusion, uptitration of neurohumoral blockers after an HF hospitalization is more frequently performed in younger patients with low co-morbidity burden. RAS-blocker uptitration independently predicts clinical outcome in patients with HFrEF but not in those with HFpEF. (C) 2013 Elsevier Inc. All rights reserved. | Document URI: | http://hdl.handle.net/1942/16186 | ISSN: | 0002-9149 | e-ISSN: | 1879-1913 | DOI: | 10.1016/j.amjcard.2013.08.013 | ISI #: | 000328799200012 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2015 |
Appears in Collections: | Research publications |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
verbrugge 1.pdf Restricted Access | Published version | 622.68 kB | Adobe PDF | View/Open Request a copy |
SCOPUSTM
Citations
13
checked on Sep 5, 2020
WEB OF SCIENCETM
Citations
19
checked on Apr 22, 2024
Page view(s)
54
checked on Jul 22, 2022
Download(s)
50
checked on Jul 22, 2022
Google ScholarTM
Check
Altmetric
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.