Abstract 17051: Relationship Between Neurohormonal Blockade Dose and Clinical Outcome in Patients With Heart Failure With Recovered Ejection Fraction
Introduction: Heart failure (HF) patients who recover left ventricular function (HF-Recovered) have reported to have a different prognosis compared to HF with reduced or preserved ejection fraction (EF). However, no study has analyzed the dosage of neurohormonal blockade in these patients.
Hypothesis: Higher dose of neurohormonal blockade might be important for better outcomes in HF-Recovered patients.
Methods: HF-Recovered patients were defined with left ventricular EF ≥40% at time of study entry and retrospectively checked EF <40%. 256 patients were enrolled between Mars 2009 and September 2014.
Results: Of the study population, 48.8% received <50% of the target dose of angiotensin-converting enzymes inhibitors (ACEIs)/angiotensin-receptor blockers (ARBs), whereas 51.2% received ≥50% of the target dose at time of EF ≥40%. 55.5% received <50% of the target dose of β-blockers (BBs), whereas 44.5% received ≥50% of the target dose. 31.3% increased the dose of ACEIs/ARBs or BBs at time of EF ≥40% (uptitration group), and 68.8% maintained the doses (maintenance group). During an average of 29.8 months of follow-up, 35 patients (13.7%) were died. In multivariable Cox proportional hazard analysis, ≥50% of the target dose of BBs was associated with lower all-cause mortality (HR=0.38, 95% CI 0.16-0.88, p=0.024). This dose-survival relationship was not the case for ACEIs/ARBs. Figure shows survival curves according to the uptitration or dose of BBs at time of EF ≥40%. Dose of BBs at time of EF ≥40% was lower among uptitration group than maintenance group. However, last follow-up doses of BBs between two groups were the same. Moreover, higher dose of BBs at time of EF recovery was associated with higher last follow-up dose.
Conclusions: The dose of BBs was associated with mortality in HF-Recovered patients. High dose of neurohormonal blockade, especially BBs may prevent future adverse events, even if EF was recovered to ≥40% suggesting the importance of dose-uptitrating effort.
Author Disclosures: M. Kim: None. H. Choi: None. J. Park: None. J. Kim: None. Y. Jeong: None. J. Kim: None.
- © 2015 by American Heart Association, Inc.