Abstract 15177: Uptitration of Neurohumoral Blockers in Hospitalized Heart Failure Patients With Reduced versus Preserved Ejection Fraction
Objective: To assess the impact of renin angiotensin system (RAS) blocker and β-blocker uptitration in heart failure patients with reduced (HFrEF) versus preserved (HFpEF) ejection fraction after a hospital admission.
Background: In ambulatory HFrEF patients, RAS and β-blockers at guideline-recommended target dose reduce all-cause mortality and readmissions. Benefits in HFpEF, as well as uptitration after a hospitalization, remain uncertain.
Methods: In consecutive patients (209 HFrEF and 108 HFpEF with ejection fraction <40% and ≥40%, respectively), RAS and β-blocker dose changes were followed during 6 months after an index heart failure hospitalization. Patients with RAS and β-blocker dose increase ≥10% of the recommended target dose were compared to patients without uptitration.
Results: Patients who received uptitration were significantly younger, with a higher heart rate and better renal function. Both RAS and β-blocker uptitration were associated with significant reductions in the composite end-point of all cause mortality or heart failure readmission in HFrEF [HR(95%CI)=0.36(0.22-0.60) and 0.51(0.32-0.81), respectively]. After correction for age, heart rate, blood pressure and renal function, this association remained significant for RAS blockers [HR(95%CI)=0.54(0.31-0.93); P-value=0.025], but not for β-blockers [HR(95%CI)=0.65(0.40-1.07); P-value=0.093]. No benefit of RAS or β-blocker uptitration was observed in HFpEF.
Conclusion: Uptitration of neurohumoral blockers after a heart failure hospitalization is more feasible in younger patients with low co-morbidity burden. RAS blocker uptitration independently predicts clinical outcome in HFrEF but not HFpEF patients.
- © 2013 by American Heart Association, Inc.