The independent reduction in mortality associated with guideline-directed medical therapy in patients with coronary artery disease and heart failure with reduced ejection fraction
Open accessAbstract
Aims: Guideline-directed medical therapy (GDMT) is underutilized in patients with coronary artery disease (CAD). However, there are no studies evaluating the impact of GDMT adherence on mortality among patients with CAD and heart failure with reduced ejection fraction (HFrEF). We sought to investigate the association of GDMT adherence with long-term mortality in patients with CAD and HFrEF. Methods and results: Surgical Treatment for Ischaemic Heart Failure (STICH) was a trial of patients with an left ventricular ejection fraction ≤35% and CAD amenable to coronary artery bypass graft surgery (CABG) who were randomized to CABG plus medical therapy (N = 610) or medical therapy alone (N = 602). Median follow-up time was 9.8 years. We defined GDMT for the treatment of CAD and HFrEF as the combination of at least one antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The primary outcome was all-cause mortality. Assessment of the independent association between GDMT and mortality was performed using multivariable Cox regression with GDMT as a time-dependent covariate. In the CABG arm, 63.6% of patients were on GDMT throughout the study period compared to 66.5% of patients in the medical therapy arm (P = 0.3). GDMT was independently associated with a significant reduction in mortality (hazard ratio 0.65, 95% confidence interval 0.56–0.76; P < 0.001). Conclusion: GDMT is associated with reduced mortality in patients with CAD and HFrEF independent of revascularization with CABG. Strategies to improve GDMT adherence in this population are needed to maximize survival.
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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 [3]
The Introduction describes a study of guideline-directed medical therapy and mortality in patients who already had coronary artery disease and reduced ejection fraction. The Clinical implications section discusses early initiation of therapy, not early diagnosis or a reduced risk of developing LVSD. Searches for early diagnosis and LVSD prevention found no passage addressing the claimed effect. (LLM, conf=0.76)
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Detection of Left Ventricular Systolic Dysfunction From Electrocardiographic Images
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- Authors
- Wolfe, N. K., Mitchell, J. D., & Brown, D. L.
- Affiliations
- Washington University in St. Louis (US)
- Corresponding author
- Brown, David L
- Venue
- European Heart Journal - Quality of Care and Clinical Outcomes
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-04-23
- Volume
- 7
- Issue
- 4
- Pages
- 416-421
- ISSN
- 2058-1742 (ISSN-L)
- 2058-5225
- PMC
- PMC8294676
- OpenAlex
- W3020119882
- Cited by
- 27
- References
- 2
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 4 · 2023: 7 · 2022: 3 · 2021: 2 · 2020: 1
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- European Heart Journal - Quality of Care and Clinical Outcomes (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR002345)
- 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 › Cardiac Health and Mental Health
- Keywords
- guideline-directed medical therapy, coronary artery disease, heart failure with reduced ejection fraction, mortality, medication adherence, coronary artery bypass grafting, STICH trial, antiplatelet therapy, statins, beta-blockers, ACE inhibitors, angiotensin receptor blockers, revascularization
- MeSH terms
- Coronary Artery Disease, Heart Failure, Humans, Stroke Volume, Ventricular Function, Left, Angiotensin Receptor Antagonists
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