P3369Impact of optimal medical therapy on one-year outcomes in acute decompensated heart failure in Japan

Abstract

Background: Acute heart failure has become a global health problem because of increased mortality and re-hospitalization. Current treatment guidelines have recommended that optimizing medical therapy with neurohormonal blockade should be used for patients with acute decompensated heart failure (ADHF). However, in the real world, eligible patients who should be treated with optimal medical therapy (OMT) before hospital discharge have not received it. Purpose(s): The purpose of the present study was to identify characteristics and prognosis associated with OMT, and to examine an association of OMT during 1-year after onset of ADHF in Japanese daily practice. Method(s): A total of 1369 consecutive patients with ADHF (746 men, 623 women) in two tertiary medical centers from November 2009 to September 2015 were enrolled. OMT was defined as concurrent use of beta-adrenergic receptor blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aldosterone antagonists. One-year adverse events were defined as all-cause mortality or re-hospitalization due to heart failure after hospital discharge. To statistically minimize the differences in each group, a propensity-matched analysis was performed. Result(s): Of all patients, 238 patients (18.8%) received OMT at hospital discharge. Median length of hospital stay was 16 (interquartile range 11-25) days. In subjects receiving OMT, the frequency of men and the prevalence of reduced left ventricular ejection fraction (<40%) were significantly greater, whereas age, the prevalence of concomitant chronic kidney disease (estimated glomerular filtration rate, <50 mL min-1 1.73 m-2) or chronic obstructive pulmonary disease were lower, compared to those without. The incidence of adverse events during 1-year follow-up was significantly lower in patients with OMT than those without (19.8% vs. 35.3%, P<0.001). Cox multivariate analysis revealed that OMT, age, systolic blood pressure, the prevalence of chronic kidney disease and anemia were significant (P<0.05) and independent predictors for adverse events. In 232 patients matched after propensity score analysis, cox multivariate analysis revealed that OMT was also an independent predictor of reducing adverse events (hazard ratio 0.74, 95% confidence interval 0.60 to 0.90, P=0.002). In the analysis according to reduced left ventricular ejection fraction or not, OMT was independently associated with the reduction of adverse events only in patients with reduced ejection fraction (hazard ratio 0.67, 95% confidence interval 0.47 to 0.94, P=0.019). Conclusion(s): In a propensity score-matched analysis in Japanese ADHF patients, OMT was associated with improving prognosis especially in patients with reduced left ventricular ejection fraction. Furthermore, our data may suggest that early initiation of OMT will require in subjects with chronic kidney disease for the management of ADHF.