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.
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 language | English |
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Article number | S120 |
Number of pages | 1 |
Journal | Heart, Lung and Circulation |
Volume | 30 |
Issue number | Supp. 3 |
DOIs | |
Publication status | Published - 3 Jan 2021 |
Externally published | Yes |
Keywords
- Heart Failure With Reduced Ejection Fraction
- HFrEF
- de novo HFrEF
- chronic HFrEF
- Cardiovascular outcomes