TY - JOUR
T1 - Heart failure medication dosage and survival in women and men seen at outpatient clinics
AU - Bots, Sophie Heleen
AU - Onland-Moret, N. Charlotte
AU - Tulevski, Igor I.
AU - Van Der Harst, Pim
AU - Cramer, Maarten J.M.
AU - Asselbergs, Folkert W.
AU - Somsen, G. Aernout
AU - Den Ruijter, Hester M.
N1 - Funding Information:
Netherlands. FWA is supported by UCL Hospitals NIHR Biomedical Research Centre.
Funding Information:
Funding This work was supported by the Dutch Cardiovascular Alliance consortium DCVA IMPRESS (2020B004) and ERC Consolidator grant UCARE (866478).
Publisher Copyright:
©
PY - 2021/11/1
Y1 - 2021/11/1
N2 - OBJECTIVE: Women with heart failure with reduced ejection fraction (HFrEF) may reach optimal treatment effect at half of the guideline-recommended medication dose. This study investigates prescription practice and its relation with survival of patients with HF in daily care.METHODS: Electronic health record data from 13 Dutch outpatient cardiology clinics were extracted for HF receiving at least one guideline-recommended HF medication. Dose changes over consecutive prescriptions were modelled using natural cubic splines. Inverse probability-weighted Cox regression was used to assess the relationship between dose (reference≥50% target dose) and all-cause mortality.RESULTS: The study population comprised 561 women (29% HFrEF (ejection fraction (EF)<40%), 49% heart failure with preserved ejection fraction (EF≥50%); HFpEF and 615 men (47% and 25%, respectively). During a median follow-up of 3.7 years, 252 patients died (48% women; 167 HFrEF, 84 HFpEF). Nine hundred thirty-four patients (46% women) received ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 795 (48% women) beta blockers and 178 (42% women) mineralocorticoid receptor antagonists (MRAs). In both sexes, the mean target dose across prescriptions was 50% for ACEI/ARBs and beta blockers, and 100% for MRAs. ACEI/ARB dose of <50% was associated with lower mortality in women but not in men with HFrEF. This was not seen in patients with HFpEF. Beta-blocker dose was not associated with all-cause mortality.CONCLUSION: Patients with HF seen in outpatient cardiology clinics receive half of the guideline-recommended medication dose. Lower ACEI/ARB dose was associated with improved survival in women with HFrEF. These results underscore the importance of (re)defining optimal medical therapy for women with HFrEF.
AB - OBJECTIVE: Women with heart failure with reduced ejection fraction (HFrEF) may reach optimal treatment effect at half of the guideline-recommended medication dose. This study investigates prescription practice and its relation with survival of patients with HF in daily care.METHODS: Electronic health record data from 13 Dutch outpatient cardiology clinics were extracted for HF receiving at least one guideline-recommended HF medication. Dose changes over consecutive prescriptions were modelled using natural cubic splines. Inverse probability-weighted Cox regression was used to assess the relationship between dose (reference≥50% target dose) and all-cause mortality.RESULTS: The study population comprised 561 women (29% HFrEF (ejection fraction (EF)<40%), 49% heart failure with preserved ejection fraction (EF≥50%); HFpEF and 615 men (47% and 25%, respectively). During a median follow-up of 3.7 years, 252 patients died (48% women; 167 HFrEF, 84 HFpEF). Nine hundred thirty-four patients (46% women) received ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 795 (48% women) beta blockers and 178 (42% women) mineralocorticoid receptor antagonists (MRAs). In both sexes, the mean target dose across prescriptions was 50% for ACEI/ARBs and beta blockers, and 100% for MRAs. ACEI/ARB dose of <50% was associated with lower mortality in women but not in men with HFrEF. This was not seen in patients with HFpEF. Beta-blocker dose was not associated with all-cause mortality.CONCLUSION: Patients with HF seen in outpatient cardiology clinics receive half of the guideline-recommended medication dose. Lower ACEI/ARB dose was associated with improved survival in women with HFrEF. These results underscore the importance of (re)defining optimal medical therapy for women with HFrEF.
KW - electronic health records
KW - epidemiology
KW - heart failure
UR - http://www.scopus.com/inward/record.url?scp=85110782594&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2021-319229
DO - 10.1136/heartjnl-2021-319229
M3 - Article
C2 - 34261736
AN - SCOPUS:85110782594
SN - 1355-6037
VL - 107
SP - 1748
EP - 1755
JO - Heart
JF - Heart
IS - 21
ER -