Trends in Calcium Channel Blocker Use in Patients with Heart Failure with Reduced Ejection Fraction and Comorbid Atrial Fibrillation.
Aged
Aged, 80 and over
Atrial Fibrillation
/ complications
Calcium Channel Blockers
/ therapeutic use
Cohort Studies
Contraindications, Drug
Female
Heart Failure
/ complications
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Patient Discharge
Practice Patterns, Physicians'
/ trends
Retrospective Studies
Risk Factors
Sex Factors
Stroke Volume
Atrial fibrillation
Calcium channel blocker
Heart failure
Journal
The American journal of medicine
ISSN: 1555-7162
Titre abrégé: Am J Med
Pays: United States
ID NLM: 0267200
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
07
05
2021
revised:
31
05
2021
accepted:
01
06
2021
pubmed:
11
7
2021
medline:
15
12
2021
entrez:
10
7
2021
Statut:
ppublish
Résumé
Heart failure with reduced ejection fraction and atrial fibrillation commonly coexist. Most calcium channel blockers are not recommended in heart failure with reduced ejection fraction, but their use has been seldom evaluated. For patients with heart failure with reduced ejection fraction and comorbid atrial fibrillation, we sought to 1) determine the proportion discharged on contraindicated calcium channel blockers, 2) describe how clinicians' use of these medications at discharge have changed over time, and 3) identify predictors for contraindicated calcium channel blocker prescription at discharge. We analyzed 395 patients discharged with heart failure with reduced ejection fraction and atrial fibrillation between 2008 and 2018. Discharge on a contraindicated calcium channel blocker (any calcium channel blocker except amlodipine) was the primary outcome. Changes in calcium channel blocker prescription over time were evaluated with a Cochran-Armitage trend test. Multivariable logistic regression was used to identify predictors of calcium channel blocker prescription at discharge. Twenty-nine (7.3%) patients were discharged on a contraindicated calcium channel blocker without change over time (P One in 14 patients with heart failure with reduced ejection fraction and comorbid atrial fibrillation were discharged on a contraindicated calcium channel blocker, without change over time. Most patients were discharged on multiple atrioventricular nodal blockers, highlighting potential need for greater coordination between discharging physicians, pharmacists, and electrophysiology.
Sections du résumé
BACKGROUND
Heart failure with reduced ejection fraction and atrial fibrillation commonly coexist. Most calcium channel blockers are not recommended in heart failure with reduced ejection fraction, but their use has been seldom evaluated. For patients with heart failure with reduced ejection fraction and comorbid atrial fibrillation, we sought to 1) determine the proportion discharged on contraindicated calcium channel blockers, 2) describe how clinicians' use of these medications at discharge have changed over time, and 3) identify predictors for contraindicated calcium channel blocker prescription at discharge.
METHODS
We analyzed 395 patients discharged with heart failure with reduced ejection fraction and atrial fibrillation between 2008 and 2018. Discharge on a contraindicated calcium channel blocker (any calcium channel blocker except amlodipine) was the primary outcome. Changes in calcium channel blocker prescription over time were evaluated with a Cochran-Armitage trend test. Multivariable logistic regression was used to identify predictors of calcium channel blocker prescription at discharge.
RESULTS
Twenty-nine (7.3%) patients were discharged on a contraindicated calcium channel blocker without change over time (P
CONCLUSION
One in 14 patients with heart failure with reduced ejection fraction and comorbid atrial fibrillation were discharged on a contraindicated calcium channel blocker, without change over time. Most patients were discharged on multiple atrioventricular nodal blockers, highlighting potential need for greater coordination between discharging physicians, pharmacists, and electrophysiology.
Identifiants
pubmed: 34245675
pii: S0002-9343(21)00416-2
doi: 10.1016/j.amjmed.2021.06.013
pmc: PMC8605988
mid: NIHMS1722130
pii:
doi:
Substances chimiques
Calcium Channel Blockers
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1413-1418.e1Subventions
Organisme : NCATS NIH HHS
ID : TL1 TR002242
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
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