Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation

Min Soo Ahn, Byung Su Yoo, Junghan Yoon, Seung Hwan Lee, Jang Young Kim, Sung Gyun Ahn, Young Jin Youn, Jun Won Lee, Jung Woo Son, Hye Sim Kim, Dae Ryong Kang, Hyun Jai Cho, Hae Young Lee, Eun Seok Jeon, Seok Min Kang, Dong Ju Choi, Myeong Chan Cho

Research output: Contribution to journalArticle

Abstract

Objectives This study evaluated the relationship between guideline adherence for recommended therapy on discharge and relevant 60-day and 1-year clinical outcomes in patients with acute heart failure (HF) with reduced ejection fraction and atrial fibrillation (AF). Methods Of 5625 acute patients with HF in the Korean Acute Heart Failure registry, 986 patients with HF and documented AF were analysed. Guideline adherence scores were calculated for the prescription of ACE inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists and anticoagulants. Results In patients with HF with AF, there was a significant trend of reduced 60-day and 1-year mortality rates and the composite end point with guideline adherence. According to the Cox proportion hazard model, poor adherence was associated with a significantly higher risk of 60-day mortality (HR 4.75; 95% CI 1.77 to 12.74) and the composite end point (HR 2.36; 95% CI 1.33 to 4.18) compared with good adherence. Furthermore, poor adherence was associated with a significantly higher risk of 1-year mortality compared with moderate (HR 1.64; 95% CI 1.15 to 2.33) and good adherence (HR 2.34; 95% CI 1.39 to 3.97) and with a higher risk of the 1-year composite end point compared with good adherence (HR 1.58; 95% CI 1.07 to 2.33). Conclusion Better adherence to guidelines was associated with better 60-day and 1-year prognoses in patients with HF with AF.

Original languageEnglish
Pages (from-to)292-298
Number of pages7
JournalHeart
Volume106
Issue number4
DOIs
StatePublished - 1 Feb 2020

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Patient Discharge
Atrial Fibrillation
Guideline Adherence
Heart Failure
Guidelines
Mortality
Therapeutics
Mineralocorticoid Receptor Antagonists
Angiotensin Receptor Antagonists
Proportional Hazards Models
Angiotensin-Converting Enzyme Inhibitors
Anticoagulants
Prescriptions
Registries

Keywords

  • atrial fibrillation
  • heart failure
  • medication adherence

Cite this

Ahn, M. S., Yoo, B. S., Yoon, J., Lee, S. H., Kim, J. Y., Ahn, S. G., ... Cho, M. C. (2020). Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation. Heart, 106(4), 292-298. https://doi.org/10.1136/heartjnl-2019-315240
Ahn, Min Soo ; Yoo, Byung Su ; Yoon, Junghan ; Lee, Seung Hwan ; Kim, Jang Young ; Ahn, Sung Gyun ; Youn, Young Jin ; Lee, Jun Won ; Son, Jung Woo ; Kim, Hye Sim ; Kang, Dae Ryong ; Cho, Hyun Jai ; Lee, Hae Young ; Jeon, Eun Seok ; Kang, Seok Min ; Choi, Dong Ju ; Cho, Myeong Chan. / Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation. In: Heart. 2020 ; Vol. 106, No. 4. pp. 292-298.
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title = "Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation",
abstract = "Objectives This study evaluated the relationship between guideline adherence for recommended therapy on discharge and relevant 60-day and 1-year clinical outcomes in patients with acute heart failure (HF) with reduced ejection fraction and atrial fibrillation (AF). Methods Of 5625 acute patients with HF in the Korean Acute Heart Failure registry, 986 patients with HF and documented AF were analysed. Guideline adherence scores were calculated for the prescription of ACE inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists and anticoagulants. Results In patients with HF with AF, there was a significant trend of reduced 60-day and 1-year mortality rates and the composite end point with guideline adherence. According to the Cox proportion hazard model, poor adherence was associated with a significantly higher risk of 60-day mortality (HR 4.75; 95{\%} CI 1.77 to 12.74) and the composite end point (HR 2.36; 95{\%} CI 1.33 to 4.18) compared with good adherence. Furthermore, poor adherence was associated with a significantly higher risk of 1-year mortality compared with moderate (HR 1.64; 95{\%} CI 1.15 to 2.33) and good adherence (HR 2.34; 95{\%} CI 1.39 to 3.97) and with a higher risk of the 1-year composite end point compared with good adherence (HR 1.58; 95{\%} CI 1.07 to 2.33). Conclusion Better adherence to guidelines was associated with better 60-day and 1-year prognoses in patients with HF with AF.",
keywords = "atrial fibrillation, heart failure, medication adherence",
author = "Ahn, {Min Soo} and Yoo, {Byung Su} and Junghan Yoon and Lee, {Seung Hwan} and Kim, {Jang Young} and Ahn, {Sung Gyun} and Youn, {Young Jin} and Lee, {Jun Won} and Son, {Jung Woo} and Kim, {Hye Sim} and Kang, {Dae Ryong} and Cho, {Hyun Jai} and Lee, {Hae Young} and Jeon, {Eun Seok} and Kang, {Seok Min} and Choi, {Dong Ju} and Cho, {Myeong Chan}",
year = "2020",
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Ahn, MS, Yoo, BS, Yoon, J, Lee, SH, Kim, JY, Ahn, SG, Youn, YJ, Lee, JW, Son, JW, Kim, HS, Kang, DR, Cho, HJ, Lee, HY, Jeon, ES, Kang, SM, Choi, DJ & Cho, MC 2020, 'Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation', Heart, vol. 106, no. 4, pp. 292-298. https://doi.org/10.1136/heartjnl-2019-315240

Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation. / Ahn, Min Soo; Yoo, Byung Su; Yoon, Junghan; Lee, Seung Hwan; Kim, Jang Young; Ahn, Sung Gyun; Youn, Young Jin; Lee, Jun Won; Son, Jung Woo; Kim, Hye Sim; Kang, Dae Ryong; Cho, Hyun Jai; Lee, Hae Young; Jeon, Eun Seok; Kang, Seok Min; Choi, Dong Ju; Cho, Myeong Chan.

In: Heart, Vol. 106, No. 4, 01.02.2020, p. 292-298.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation

AU - Ahn, Min Soo

AU - Yoo, Byung Su

AU - Yoon, Junghan

AU - Lee, Seung Hwan

AU - Kim, Jang Young

AU - Ahn, Sung Gyun

AU - Youn, Young Jin

AU - Lee, Jun Won

AU - Son, Jung Woo

AU - Kim, Hye Sim

AU - Kang, Dae Ryong

AU - Cho, Hyun Jai

AU - Lee, Hae Young

AU - Jeon, Eun Seok

AU - Kang, Seok Min

AU - Choi, Dong Ju

AU - Cho, Myeong Chan

PY - 2020/2/1

Y1 - 2020/2/1

N2 - Objectives This study evaluated the relationship between guideline adherence for recommended therapy on discharge and relevant 60-day and 1-year clinical outcomes in patients with acute heart failure (HF) with reduced ejection fraction and atrial fibrillation (AF). Methods Of 5625 acute patients with HF in the Korean Acute Heart Failure registry, 986 patients with HF and documented AF were analysed. Guideline adherence scores were calculated for the prescription of ACE inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists and anticoagulants. Results In patients with HF with AF, there was a significant trend of reduced 60-day and 1-year mortality rates and the composite end point with guideline adherence. According to the Cox proportion hazard model, poor adherence was associated with a significantly higher risk of 60-day mortality (HR 4.75; 95% CI 1.77 to 12.74) and the composite end point (HR 2.36; 95% CI 1.33 to 4.18) compared with good adherence. Furthermore, poor adherence was associated with a significantly higher risk of 1-year mortality compared with moderate (HR 1.64; 95% CI 1.15 to 2.33) and good adherence (HR 2.34; 95% CI 1.39 to 3.97) and with a higher risk of the 1-year composite end point compared with good adherence (HR 1.58; 95% CI 1.07 to 2.33). Conclusion Better adherence to guidelines was associated with better 60-day and 1-year prognoses in patients with HF with AF.

AB - Objectives This study evaluated the relationship between guideline adherence for recommended therapy on discharge and relevant 60-day and 1-year clinical outcomes in patients with acute heart failure (HF) with reduced ejection fraction and atrial fibrillation (AF). Methods Of 5625 acute patients with HF in the Korean Acute Heart Failure registry, 986 patients with HF and documented AF were analysed. Guideline adherence scores were calculated for the prescription of ACE inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists and anticoagulants. Results In patients with HF with AF, there was a significant trend of reduced 60-day and 1-year mortality rates and the composite end point with guideline adherence. According to the Cox proportion hazard model, poor adherence was associated with a significantly higher risk of 60-day mortality (HR 4.75; 95% CI 1.77 to 12.74) and the composite end point (HR 2.36; 95% CI 1.33 to 4.18) compared with good adherence. Furthermore, poor adherence was associated with a significantly higher risk of 1-year mortality compared with moderate (HR 1.64; 95% CI 1.15 to 2.33) and good adherence (HR 2.34; 95% CI 1.39 to 3.97) and with a higher risk of the 1-year composite end point compared with good adherence (HR 1.58; 95% CI 1.07 to 2.33). Conclusion Better adherence to guidelines was associated with better 60-day and 1-year prognoses in patients with HF with AF.

KW - atrial fibrillation

KW - heart failure

KW - medication adherence

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