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KMID : 0191120190340170133
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Journal of Korean Medical Science
2019 Volume.34 No. 17 p.133 ~ p.133
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Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure
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Ahn Min-Soo
Yoo Byung-Su
Yoon Jung-Han
Lee Seung-Hwan
Kim Jang-Young
Ahn Sung-Gyun
Youn Young-Jin
Lee Jun-Won
Son Jung-Woo
Kim Hye-Sim
Kang Dae-Ryong
Lee Sang-Eun
Cho Hyun-Jai
Lee Hae-Young
Jeon Eun-Seok
Kang Seok-Min
Choi Dong-Ju
Cho Myeong-Chan
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Abstract
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Background: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately.
Methods: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist.
Results: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34?0.95), mortality (HR, 0.41; 95% CI, 0.24?0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36?0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41?0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47?0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint.
Conclusion: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.
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KEYWORD
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De Novo Acute Heart Failure, Acute Decompensated Heart Failure, Guideline-Directed Therapy
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