Heart failure treatment up-titration and outcome and age: an analysis of BIOSTAT-CHF.
ACE inhibitor
Angiotensin receptor blocker
Beta-blocker
Elderly
Up-titration
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
revised:
22
01
2020
received:
04
11
2019
accepted:
24
02
2020
pubmed:
28
3
2020
medline:
6
7
2021
entrez:
28
3
2020
Statut:
ppublish
Résumé
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. 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). 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.
Substances chimiques
Adrenergic beta-Antagonists
0
Angiotensin Receptor Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
436-444Subventions
Organisme : Chief Scientist Office
ID : PCL/17/07
Pays : United Kingdom
Organisme : European Commission: FP7-242209-BIOSTAT-CHF
Organisme : NHS Education for Scotland/Chief Scientist Office Postdoctoral Clinical Lectureship
ID : PCL/17/07
Informations de copyright
© 2020 European Society of Cardiology.
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