Early Initiation of Guideline-Directed Medical Therapy Improves Outcomes in Heart Failure with Reduced Ejection Fraction Patients without Significant Risk of Nephrotoxicity.
Rattachement africain : tw. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Background: Current evidence supports the early initiation of all guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF), but clinical inertia persists in real-world practice. Methods: Clinical data of 343 HFrEF patients hospitalized from January 2018 to December 2019 were collected, and they were followed for at least 3 years. We analyzed the benefits of optimizing GDMT at hospital discharge, the reasons for underprescription of GDMT, and factors associated with different outcomes after multivariate adjustments. Results: Starting at least 3 pillars of GDMT at hospital discharge significantly reduced the risks of all-cause mortality, cardiovascular (CV) death, and heart failure hospitalization (hazard ratio = 0.22, 0.21, 0.28, respectively; all p < 0.001). Renal impairment was the major factor associated with the non-optimization of GDMT, and 78.4% of patients receiving fewer than 3 pillars of GDMT had a baseline chronic kidney disease stage 3-5. However, the prescription of GDMT was not associated with any observable risk of adverse renal outcomes. Conclusions: This study demonstrated the CV benefits and safety regarding renal outcomes with the early initiation of GDMT in HFrEF patients. Efforts should be made to address the disparity between evidence-based medicine and daily practice.
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National Taiwan University pays non établi dans la noticeUniversité ou école supérieure
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Far Eastern Memorial Hospital Department of Nuclear Medicine pays non établi dans la noticeÉtablissement de santé
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National Defense Medical Center pays non établi dans la noticeÉtablissement de santé
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National Yang Ming Chiao Tung University pays non établi dans la noticeUniversité ou école supérieure
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Yuan Ze University Graduate Institute of Medicine pays non établi dans la noticeUniversité ou école supérieure
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College of Medicine Graduate Institute of Anatomy and Cell Biology pays non établi dans la noticeUniversité ou école supérieure
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Cardiovascular Medical Center Division of Cardiology pays non établi dans la noticeÉtablissement de santé
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Tri-Service General Hospital Division of Cardiology pays non établi dans la noticeÉtablissement de santé
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School of Medicine pays non établi dans la noticeUniversité ou école supérieure
National Taiwan University, Department of Nuclear Medicine — Far Eastern Memorial Hospital et National Defense Medical Center, avec 6 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.