Srivastava Pratyaksh K, Klomhaus Alexandra M, Rafique Asim, Desai Pooja S, Daniels Lori B, Yancy Clyde W, Yang Eric H, Fonarow Gregg C, Parikh Rushi V
Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States of America.
Department of Medicine, Statistics Core, UCLA, Los Angeles, CA, United States of America.
Am Heart J Plus. 2024 Aug 2;45:100440. doi: 10.1016/j.ahjo.2024.100440. eCollection 2024 Sep.
The association of prior to admission guideline-directed medical therapy (GDMT) use in patients hospitalized with Heart Failure with Reduced Ejection Fraction (HFrEF, ejection fraction ≤40 %) and Coronavirus Disease 2019 (COVID-19) with in-hospital outcomes has not been well studied.
DESIGN/SETTING/PARTICIPANTS/INTERVENTIONS/OUTCOME MEASURES: Using the American Heart Association's Get With The Guidelines Heart Failure Registry, we identified HFrEF patients presenting with acute decompensated heart failure (ADHF) and compared rates of GDMT prescription between those presenting prior to and during the pandemic. In a subgroup of patients with a concomitant COVID-19 diagnosis, we evaluated the association of prior to admission GDMT use with in-hospital mortality and severe COVID-19.
23,899 patients were admitted with HFrEF during the pandemic (2/16/20-3/24/21) and 26,459 patients were admitted in the year prior (2/16/19-2/15/20). In this overall cohort, prior to admission ACEI/ARB/ARNI (45.6 % vs 48.1 %, p < 0.0001) and BB (56.9 % vs 62.4 %, p < 0.0001) use was lower among admitted HFrEF patients during the pandemic when compared to the year prior. Rates of ACEI/ARB/ARNI, MRA, and triple therapy (ACE/ARB/ARNI + BB + MRA) prescription at discharge were higher during the pandemic compared to the year prior. Among a subgroup of those with HFrEF and COVID-19 (n = 333), prior to admission GDMT use was not associated with in-hospital mortality or severe COVID-19.
We found no association between prior to admission GDMT use and in-hospital mortality or severe COVID-19 among HFrEF patients admitted with ADHF and COVID-19. GDMT prescription at discharge for HFrEF patients overall has remained either similar or improved during the pandemic.
入院前指南指导的药物治疗（GDMT）在射血分数降低的心力衰竭（HFrEF，射血分数≤40%）合并2019冠状病毒病（COVID-19）住院患者中的应用与院内结局之间的关联尚未得到充分研究。
设计/地点/参与者/干预措施/结局指标：利用美国心脏协会的“遵循指南-心力衰竭注册研究”，我们确定了出现急性失代偿性心力衰竭（ADHF）的HFrEF患者，并比较了大流行之前和期间入院患者的GDMT处方率。在伴有COVID-19诊断的患者亚组中，我们评估了入院前使用GDMT与院内死亡率和严重COVID-19之间的关联。
在大流行期间（2020年2月16日至2021年3月24日），有23899例患者因HFrEF入院，前一年（2019年2月16日至2020年2月15日）有26459例患者入院。在这个总体队列中，与前一年相比，大流行期间入院的HFrEF患者入院前使用ACEI/ARB/ARNI（45.6%对48.1%，p<0.0001）和β受体阻滞剂（BB，56.9%对62.4%，p<0.0001）的比例较低。与前一年相比，大流行期间出院时ACEI/ARB/ARNI、MRA和三联疗法（ACE/ARB/ARNI+BB+MRA）的处方率更高。在HFrEF合并COVID-19患者亚组（n=333）中，入院前使用GDMT与院内死亡率或严重COVID-19无关。
我们发现，因ADHF和COVID-19入院的HFrEF患者入院前使用GDMT与院内死亡率或严重COVID-19之间无关联。在大流行期间，HFrEF患者出院时的GDMT处方总体上保持相似或有所改善。
