Abstract 15781: High Dose Guideline-Directed Medical Therapy for Heart Failure at Discharge Improves 1-Year Mortality in African-Americans but Not Hypertensive Patients
BACKGROUND: Guideline-directed medical therapy (GDMT) for chronic heart failure has resulted in improved outcomes in readmission and mortality; yet, the effect of achieving high doses (>50% target) GDMT at discharge is unknown. We hypothesized that patients discharged at >50% target GDMT compared to ≤50% target GDMT would have reduced readmission and mortality.
METHODS: We retrospectively evaluated 1408 patients who presented with a heart failure admission and were discharged alive between October 2011 and October 2012 at our academic (Aca) and academic-community hybrid (Hybrid) medical centers. Logistic regression and multinomial logit models were used to assess for 90-day and 1-year readmission and mortality based upon GDMT dosing including ace inhibitors, angiotensin receptor blockers, beta blockers, and aldosterone receptor blockers.
RESULTS: Patients differed between the two categories by race [Aca 233 (21.3%) African-Americans (AA) versus Hybrid 227 (72.5%) AA, p<0.001] and systolic blood pressure (Aca 118 mmHg versus Hybrid 127mmHg, p<0.0001). There was no significant difference in readmission based upon GDMT target dose and discharge location. However for all patients combined, Aca and Hybrid, there was a significant reduction in mortality in patients taking >50% target GDMT compared to ≤50% target GDMT at 90-day [Odds Ratio (OR) 0.34, 95% Confidence Interval(CI) (0.16, 0.76)], 1-year [OR 0.58, 95%CI (0.37, 0.93)], (Table) and in AA at 1-year [OR 0.28, 95%CI (0.10, 0.76)]. This relationship was seen primarily at our Aca but not reproduced at our Hybrid.
CONCLUSION: The combination of all GDMT dosed at >50% target compared to ≤50% target resulted in reduced mortality especially in AA. However, at our Hybrid center where patients tended to be hypertensive, higher dose of GDMT produced similar results to lower doses.
Author Disclosures: K. Breathett: None. R. Sturdivant: None. D. Carpenter: None. R. Foraker: None. P. Binkley: None. W.T. Abraham: None.
- © 2014 by American Heart Association, Inc.