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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 B.
Dupont, Matthias
Tang, W. H. Wilson
MULLENS, Wilfried
Issue Date: 2013
Citation: 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.
URI: http://hdl.handle.net/1942/16186
DOI: 10.1016/j.amjcard.2013.08.013
ISI #: 000328799200012
ISSN: 0002-9149
Category: A1
Type: Journal Contribution
Validation: ecoom, 2015
Appears in Collections: Research publications

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