Heart Failure Hospitalization and Guideline-Directed Prescribing Patterns Among Heart Failure With Reduced Ejection Fraction Patients
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Objectives The authors sought to evaluate the association of heart failure hospitalization (HFH) with guideline-directed medical therapy (GDMT) prescribing patterns among patients with heart failure with reduced ejection fraction (HFrEF). Background HFH represents an important opportunity to titrate GDMT among patients with HFrEF. Methods The CHAMP-HF (Change the Management of Patients With Heart Failure) registry is a prospective registry of adults with HFrEF (ejection fraction ≤40%). Using data from the CHAMP-HF registry (N = 4,365), adjusted time-to-event models were created to study the association of HFH with GDMT prescribing patterns. Results HFH (compared with no HFH) was positively associated with initiation of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor, beta-blocker, and mineralocorticoid receptor antagonist (MRA). HFH positively associated with dose escalation of ACE inhibitor/ARB (probability ratio: 1.71, 95% confidence interval [CI]: 1.36 to 2.16) and MRA (probability ratio: 8.71, 95% CI: 4.19 to 18.10). In those on prior therapy, HFH was associated with discontinuation and de-escalation of all classes of GDMT. ACE inhibitor/ARB, angiotensin receptor-neprilysin inhibitor, beta-blocker, and MRA de-escalation/discontinuation after HFH was associated with increased risk of all-cause mortality with hazard ratios of 3.82 (95% CI: 2.42 to 6.03), 4.76 (95% CI: 2.06 to 11.03), 2.94 (95% CI: 2.04 to 4.25), and 4.81 (95% CI: 2.61 to 8.87), respectively. Conclusions HFH positively associated with changes in GDMT, including initiation, dose escalation, discontinuation, and dose de-escalation. De-escalation/discontinuation of GDMT after HFH associated with increased risk of all-cause mortality. Educational endeavors are needed to ensure GDMT is not inappropriately held in the setting of HFH. For those in whom GDMT must be held/decreased, improvement tools at discharge and post-discharge titration clinics may help ensure lifesaving GDMT regimens remain optimized.
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Early diagnosis can effectively mitigate the risk of LVSD.
“Early diagnosis can effectively mitigate this risk2–4”
From Detection of left ventricular systolic dysfunction from single-lead electrocardiography adapted for portable and wearable devices (2023) · cites this paper as [2]
The Discussion (page unavailable) examines prescribing changes after heart-failure hospitalization in patients who already have reduced ejection fraction. Searches for early diagnosis, detection, and prevention found no passage saying that early diagnosis mitigates the risk of LVSD. (LLM, conf=0.73)
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- Authors
- Srivastava, P. K., DeVore, A. D., Hellkamp, A. S., Thomas, L., Albert, N. M., Butler, J., Patterson, J. H., Spertus, J. A., Williams, F. B., Duffy, C. I., Hernandez, A. F., & Fonarow, G. C.
- Affiliations
- University of California, Los Angeles (US)
- Duke University (US)
- Duke Clinical Research Institute (US)
- Cleveland Clinic (US)
- University of Mississippi Medical Center (US)
- University of North Carolina at Chapel Hill (US)
- University of Missouri–Kansas City (US)
- Novartis (United States) (US)
- Corresponding author
- Fonarow, Gregg C.
- ORCID
- Venue
- JACC: Heart Failure
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 9
- Issue
- 1
- Pages
- 28-38
- ISSN
- 2213-1779 (ISSN-L)
- OpenAlex
- W3112316946
- Cited by
- 71
- References
- 5
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 10 · 2023: 26 · 2022: 13 · 2021: 9 · 2020: 1
- FWCI
- 7.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Merck
- Boehringer Ingelheim
- Novartis
- Amgen
- Boston Scientific Corporation
- National Heart, Lung, and Blood Institute
- Bayer Fund
- American Heart Association
- American Regent
- AstraZeneca
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- heart failure with reduced ejection fraction, heart failure hospitalization, guideline-directed medical therapy, prescribing patterns, angiotensin receptor-neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists, dose escalation, dose de-escalation, all-cause mortality, dose titration, guideline adherence, inappropriate prescribing
- MeSH terms
- Adult, Aftercare, Angiotensin-Converting Enzyme Inhibitors, Heart Failure, Hospitalization, Humans, Patient Discharge, Stroke Volume, Angiotensin Receptor Antagonists
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