Shoji Satoshi, Kaltenbach Lisa, Granger Bradi B, Fonarow Gregg C, Al-Khalidi Hussein R, Albert Nancy M, Butler Javed, Allen Larry A, Lanfear David E, Thibodeau Jennifer T, Chapman Brittany M, Oliver-McNeil Sandra M, Felker G Michael, Pina Ileana L, Granger Christopher B, Hernandez Adrian F, DeVore Adam D
Duke Clinical Research Institute Durham NC USA.
Division of Cardiology and Department of Medicine Duke University School of Medicine Durham NC USA.
J Am Heart Assoc. 2024 Dec 17;13(24):e036998. doi: 10.1161/JAHA.124.036998. Epub 2024 Dec 10.
Significant gap remains in the implementation of guideline-directed medical therapy (GDMT) in patients with heart failure after a hospitalization. We aimed to evaluate the use and titration of GDMT at discharge and over a 12-month period after hospital discharge and to identify factors associated with GDMT use and titration.
The CONNECT-HF (Care Optimization Through Patient and Hospital Engagement Clinical Trial for Heart Failure) trial evaluated the effect of a hospital and postdischarge quality improvement intervention in participants with heart failure with reduced ejection fraction. In this secondary analysis, we examined use and titration to at least 50% of the target dose of GDMTs at hospital discharge and over time. Among 4646 participants (mean age 63 years, 34% women), GDMT use did not numerically improve from discharge to 12 months: beta blockers (84%-78%), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor-neprilysin inhibitors (73%-65%), mineralocorticoid receptor antagonists (39%-36%), and sodium-glucose cotransporter 2 inhibitors (1.5%-2.1%). Achieving ≥50% of the target dose also showed little change over 12 months: beta blockers (35%-32%), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor-neprilysin inhibitors (28%-25%). For all medications, use of GDMT at discharge was associated with the use and achieving ≥50% of the target dose at 12 months.
Following a hospitalization for heart failure, GDMT use remained low and did not numerically improve over 12 months. Use of GDMT at discharge was significantly associated with the use of GDMT over time, highlighting the importance of initiating GDMT during hospitalization.
心力衰竭患者住院后，在实施指南指导的药物治疗（GDMT）方面仍存在显著差距。我们旨在评估出院时及出院后12个月内GDMT的使用和滴定情况，并确定与GDMT使用和滴定相关的因素。
CONNECT-HF（通过患者和医院参与改善心力衰竭临床治疗试验）试验评估了一项针对射血分数降低的心力衰竭参与者的医院及出院后质量改善干预措施的效果。在这项二次分析中，我们研究了出院时及随时间推移至至少50%目标剂量的GDMT的使用和滴定情况。在4646名参与者（平均年龄63岁，34%为女性）中，从出院到12个月，GDMT的使用在数值上没有改善：β受体阻滞剂（84%-78%）、血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂（73%-65%）、盐皮质激素受体拮抗剂（39%-36%）以及钠-葡萄糖协同转运蛋白2抑制剂（1.5%-2.1%）。达到≥50%目标剂量在12个月内也几乎没有变化：β受体阻滞剂（35%-32%）、血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂（28%-25%）。对于所有药物，出院时使用GDMT与12个月时的使用及达到≥50%目标剂量相关。
心力衰竭住院后，GDMT的使用仍然较低，且在12个月内数值上没有改善。出院时使用GDMT与随时间推移使用GDMT显著相关，突出了在住院期间启动GDMT的重要性。
