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Heart. 2019 Sep 6. pii: heartjnl-2019-315240. doi: 10.1136/heartjnl-2019-315240. [Epub ahead of print]

Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation.

Author information

1
Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.
2
Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea yubs@yonsei.ac.kr.
3
Center of Biomedical Data Science, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.
4
Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea.
5
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
6
Division of Cardiology, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
7
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Wonju College of Medicine, Seoul, Republic of Korea.
8
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
9
Chungbuk National University Hospital, Chungju-si, Republic of Korea.

Abstract

OBJECTIVES:

This study evaluated the relationship between guideline adherence for recommended therapy on discharge and relevant 60-day and 1-year clinical outcomes in patients with acute heart failure (HF) with reduced ejection fraction and atrial fibrillation (AF).

METHODS:

Of 5625 acute patients with HF in the Korean Acute Heart Failure registry, 986 patients with HF and documented AF were analysed. Guideline adherence scores were calculated for the prescription of ACE inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists and anticoagulants.

RESULTS:

In patients with HF with AF, there was a significant trend of reduced 60-day and 1-year mortality rates and the composite end point with guideline adherence. According to the Cox proportion hazard model, poor adherence was associated with a significantly higher risk of 60-day mortality (HR 4.75; 95% CI 1.77 to 12.74) and the composite end point (HR 2.36; 95% CI 1.33 to 4.18) compared with good adherence. Furthermore, poor adherence was associated with a significantly higher risk of 1-year mortality compared with moderate (HR 1.64; 95% CI 1.15 to 2.33) and good adherence (HR 2.34; 95% CI 1.39 to 3.97) and with a higher risk of the 1-year composite end point compared with good adherence (HR 1.58; 95% CI 1.07 to 2.33).

CONCLUSION:

Better adherence to guidelines was associated with better 60-day and 1-year prognoses in patients with HF with AF.

KEYWORDS:

atrial fibrillation; heart failure; medication adherence

PMID:
31492703
DOI:
10.1136/heartjnl-2019-315240
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