Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
J Korean Med Sci. 2021 Oct 18;36(40):e252. doi: 10.3346/jkms.2021.36.e252.
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).
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.
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; = 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; = 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; = 0.040), 1-year re-hospitalization (wHR, 0.67; 95% CI, 0.48-0.93; = 0.018), and the composite endpoint (wHR, 0.77; 95% CI, 0.59-0.99; = 0.041).
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.
本研究评估了射血分数降低的心衰（HFrEF）出院时指南依从性与伴有或不伴有房颤（AF）的急性射血分数保留心衰（HFpEF）患者相关临床结局之间的关系。
我们分析了韩国急性心衰登记研究中 707 例有记录 AF 的 HFpEF 患者和 687 例无 AF 的患者数据。根据血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂和盐皮质激素受体拮抗剂的处方，将指南依从性定义为良好或不良。对于 AF 组，还纳入了抗凝药物依从性。
在窦性心律患者中，与指南依从性良好的患者相比，指南依从性不良的患者合并症患病率较低，临床特征较好。使用逆概率治疗加权（IPTW）来解决非随机治疗分配的偏差，多变量 Cox 模型中良好的依从性与 60 天复合终点不良相关（加权风险比 [wHR]，1.74；95%置信区间 [CI]，1.01-3.00； = 0.045）。对于 AF 患者，根据依从程度，基线临床特征相似。经 IPTW 调整的分析表明，良好的依从性与 60 天复合终点显著相关（wHR，0.47；95%CI，0.27-0.79； = 0.005）。在排除华法林的分析中，良好的依从性与 60 天再住院（wHR，0.60；95%CI，0.37-0.98； = 0.040）、1 年再住院（wHR，0.67；95%CI，0.48-0.93； = 0.018）和复合终点（wHR，0.77；95%CI，0.59-0.99； = 0.041）相关。
我们的研究结果表明，在伴有 AF 的 HFpEF 患者中，HFrEF 指南的良好依从性与 60 天复合终点的改善相关。
