BIOSTAT Age Paper Full Final Manuscript inc supp IM 020320.pdf (1.47 MB)
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Heart failure treatment up-titration and outcome and age: an analysis of BIOSTAT-CHF.

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journal contribution
posted on 16.04.2020, 13:38 by Ify R. Mordi, Wouter Ouwerkerk, Stefan D. Anker, John G. Cleland, Kenneth Dickstein, Marco Metra, Leong L. Ng, Nilesh J. Samani, Dirk J. van Veldhuisen, Faiez Zannad, Adriaan A. Voors, Chim C. Lang
AIMS: Several studies have shown that older patients with heart failure with reduced ejection fraction (HFrEF) are undertreated. The aim of this study was to evaluate the association of up-titration of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) and beta-blockers on outcome across the age spectrum in HFrEF patients. METHODS AND RESULTS: We analysed HFrEF patients on sub-optimal doses of ACEI/ARB and/or beta-blockers from the BIOSTAT-CHF study stratified by age. Patients underwent a 3-month up-titration period. We used inverse probability weighting to adjust for the likelihood of successful up-titration to determine the association of achieved dose with mortality and/or heart failure hospitalisation, testing for an interaction with age. Over a median follow-up of 21 months in 1720 HFrEF patients (76.5% male, mean age 67 years), the primary outcome occurred in 558 patients. Increased percentage of target dose of ACEI/ARB and beta-blocker achieved at 3 months were both significantly associated with reduced incidence of the primary outcome, [ACEI-ARB: hazard ratio (HR) per 12.5% increase in dose: 0.92, 95% confidence interval (CI) 0.91-0.94, P < 0.001; beta-blocker: HR 0.98, 95% CI 0.95-1.00, P = 0.046], with a significant interaction with age seen for beta-blockers but not ACEI/ARB (P = 0.034 and P = 0.22, respectively). CONCLUSIONS: Achieving higher doses of ACEI/ARB was associated with improved outcome regardless of age. However, achieving higher doses of beta-blockers was only associated with improved outcome in younger, but not in older patients.

History

Citation

Eur J Heart Fail 2020

Author affiliation

Department of Cardiovascular Sciences

Version

AM (Accepted Manuscript)

Published in

Eur J Heart Fail

Publisher

Wiley

issn

1388-9842

eissn

1879-0844

Acceptance date

24/02/2020

Copyright date

2020

Available date

25/03/2020

Publisher version

https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.1799

Spatial coverage

England

Language

eng