Effect of Triple Therapy on Post-discharge Outcomes in Patients With de novo vs. Chronic Heart Failure With Reduced Ejection Fraction (HFrEF)

R. Ravikulan, C. De Pasquale, J. Harris, A. Prosser, Y. Sharma, S. Sumandasa, R. Lek, M. Le, A. Hussein, J. Gunton

Research output: Contribution to journalMeeting Abstractpeer-review

Abstract

Background

While there is growing literature comparing the characteristics of de novo HFrEF and chronic HFrEF patients, their implications on in-hospital treatment strategy are less known. Particularly, in-hospital initiation of triple therapy (TT), which include an ACEi/ARB, beta-blocker, and mineralocorticoid receptor antagonist (MRA) in de novo HFrEF remains unexplored.

Aim

We evaluated the effects of TT on post-discharge cardiovascular outcomes among de novo and chronic HFrEF inpatients

Methods

Flinders Medical Centre inpatients with a primary diagnosis of AD HFrEF (EF<40%) were studied. Data is presented as median, statistical analysis by Mann-Whitney U and Chi-square test, p<0.05 reported.

Results

Of 113 AD HFrEF patients, 38 had de novo HF (34%) and 75 had chronic HF. Compared to chronic HFrEF patients, de novo HFrEF patients were slightly younger (75 vs 78 years), less likely to have CKD (23% vs 31%), had similar length of stay (5 vs 6 days), similar EF (27% vs 28%), lower NT-proBNP (3300 vs 7700), and less 30-day readmissions (3% vs 30%). Twenty de novo patients (53%) and 35 chronic HF patients (49%) were discharged on TT. After 2.5 years, there were no significant differences in events between the de novo and chronic groups, or within the groups regardless of TT use. However, compared to chronic patients on TT, de novo patients on TT had significantly lower CV readmissions (p=0.021) and events (p=0.032), but no difference in deaths (p=0.355).

Conclusions

TT has proven mortality benefits in HFrEF, however, initiation of TT in de novo patients at first presentation may additionally reduce CV readmissions.
Original languageEnglish
Article numberS120
Number of pages1
JournalHeart, Lung and Circulation
Volume30
Issue numberSupp. 3
DOIs
Publication statusPublished - 3 Jan 2021
Externally publishedYes

Keywords

  • Heart Failure With Reduced Ejection Fraction
  • HFrEF
  • de novo HFrEF
  • chronic HFrEF
  • Cardiovascular outcomes

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