|
KMID : 0191120210360400252
|
|
Journal of Korean Medical Science
2021 Volume.36 No. 40 p.252 ~ p.252
|
|
|
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
|
|
Ahn Min-Soo
Yoo Byung-Su
Son Jung-Woo
Park Young-Jun
Lee Hae-Young
Jeon Eun-Seok
Kang Seok-Min
Choi Dong-Ju
Kim Kye-Hun
Cho Myeong-Chan
Kim Seong-Yoon
Kang Dae-Ryong
Go Tae-Hwa
|
|
|
Abstract
|
|
|
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, β-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 re-hospitalization (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.
|
|
|
KEYWORD
|
|
|
Heart Failure, Atrial Fibrillation, Guideline Adherence
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
    
|
|