Evaluation of Adherence to Guideline for Heart Failure with Reduced Ejection Fraction in Heart Failure with Preserved Ejection Fraction and with or without Atrial Fibrillation

被引：5

作者：

Ahn, Min-Soo ^{[1
]}

Yoo, Byung-Su ^{[1
]}

Son, Jung-Woo ^{[1
]}

Park, Young Jun ^{[1
]}

Lee, Hae-Young ^{[2
]}

Jeon, Eun-Seok ^{[3
]}

Kang, Seok-Min ^{[4
]}

Choi, Dong-Ju ^{[5
]}

Kim, Kye Hun ^{[6
]}

Cho, Myeong-Chan ^{[7
]}

Kim, Seong Yoon ^{[8
]}

Kang, Dae Ryong ^{[9
]}

Go, Tae-Hwa ^{[9
]}

机构：

[1] Yonsei Univ, Wonju Coll Med, Dept Internal Med, Wonju, South Korea

[2] Seoul Natl Univ Hosp, Dept Internal Med, Seoul, South Korea

[3] Sungkyunkwan Univ, Dept Internal Med, Coll Med, Seoul, South Korea

[4] Yonsei Univ, Dept Internal Med, Coll Med, Seoul, South Korea

[5] Seoul Natl Univ, Dept Internal Med, Bundang Hosp, Seongnam, South Korea

[6] Chonnam Natl Univ, Dept Internal Med, Heart Res Ctr, Gwangju, South Korea

[7] Chungbuk Natl Univ, Coll Med, Dept Internal Med, Cheongju, South Korea

[8] MetroWest Med Ctr, Framingham, MA USA

[9] Yonsei Univ, Wonju Coll Med, Dept Biostat, Wonju, South Korea

来源：

JOURNAL OF KOREAN MEDICAL SCIENCE | 2021年 / 36卷 / 40期

关键词：

Heart Failure; Atrial Fibrillation; Guideline Adherence; 2013 ACCF/AHA GUIDELINE; ASSOCIATION TASK-FORCE; AMERICAN-COLLEGE; ELDERLY-PEOPLE; OUTCOMES; MANAGEMENT; PERINDOPRIL; POPULATION; PREVALENCE;

D O I：

10.3346/jkms.2021.36.e252

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: This study evaluated the relationship between guideline adherence for heart failure (HF) with reduced ejection fraction (HFrEF) at discharge and relevant clinical outcomes in patients with acute HF with preserved ejection fraction (HFpEF) with or without atrial fibrillation (AF). Methods: We analyzed Korean Acute Heart Failure Registry data for 707 patients with HFpEF with documented AF and 687 without AF. Guideline adherence was defined as good or poor according to the prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists. Anticoagulation adherence was also incorporated for the AF group. Results: Among patients with normal sinus rhythm, those with poor guideline adherence had a reduced prevalence of comorbidities and favorable clinical characteristics when compared with those with good guideline adherence. Using inverse probability of treatment weighting (IPTW) to address the bias of nonrandom treatment assignment, good adherence was associated with a poor 60-day composite endpoint in the multivariable Cox model (weighted hazard ratio [wHR], 1.74; 95% confidence interval [CI], 1.01-3.00; P = 0.045). For patients with AF, baseline clinical characteristics were similar according to the degree of adherence. The IPTW-adjusted analysis indicated that good adherence was significantly associated with the 60-day composite endpoint (wHR, 0.47; 95% CI, 0.27-0.79; P = 0.005). In the analysis excluding warfarin, good adherence was associated with 60-day rehospitalization (wHR, 0.60; 95% CI, 0.37-0.98; P = 0.040), 1-year re-hospitalization (wHR, 0.67; 95% CI, 0.48-0.93; P = 0.018), and the composite endpoint (wHR, 0.77; 95% CI, 0.59-0.99; P = 0.041). Conclusion: Our findings indicate that good adherence to guidelines for HFrEF is associated with a better 60-day composite endpoint in patients with HFpEF with AF.

引用

页码：1 / 13

页数：13

共 30 条

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