Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate≥70bpm is unclear, we investigated the ...impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality and rehospitalization.
A retrospective analysis was performed on 370 hospitalized HF patients with heart rate≥70bpm (150 BB+ivabradine, 220 BB alone) in the Optimize Heart Failure Care Program in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, Ukraine, and Uzbekistan, from October 2015 to April 2016.
At 1month, 3months, 6months and 12months, there were fewer deaths, HF hospitalizations and overall hospitalizations in patients on BB+ivabradine vs BBs alone. At 12months, all-cause mortality or HF hospitalization was significantly lower with BB+ivabradine than BBs (adjusted hazard ratio HR 0.45 (95% confidence interval CI 0.32–0.64, P<0.0001). Significantly greater improvement was seen in quality of life (QOL) from admission to 12months with BB+ivabradine vs BBs alone (P=0.0001). With BB+ivabradine, significantly more patients achieved ≥50% target doses of BBs at 12months than on admission (82.0% vs 66.6%, P=0.0001), but the effect was non-significant with BBs alone.
Heart rate lowering therapy with BB+ivabradine started in hospitalized HF patients (heart rate≥70bpm) is associated with reduced overall mortality and re-hospitalization over the subsequent 12months. A prospective randomized trial is needed to confirm the advantages of this strategy.
•Hospitalized heart failure patients with heart rate≥70 bpm have a higher mortality risk.•In those patients beta blockers (BB) + ivabradine reduced 12-month mortality/rehospitalization vs BB alone.•A large clinical trial is needed to confirm the advantages of this strategy
BackgroundHigh heart failure (HF) re-hospitalization rate is a great challenge for patients, physicians and a health care system. This study aimed to analyze the impact of physicians’ and patients’ ...adherence to guideline-recommended therapy on HF re-hospitalizations in patients hospitalized due to worsening HF.MethodsThis analysis included data from an international prospective multicenter Optimize Heart Failure Care program collected over 12 months from 635 patients hospitalized with worsening HF. To assess physician’s adherence to guideline-recommended doses of HF medications we used a five-class guideline adherence score. Three types of adherence were definedgood adherence (use of all guideline-recommended HF medications); moderate adherence (use of more than half of recommended medications); poor adherence (use of guideline-recommended ≤50% medications). To assess patient’s adherence to recommended medications we used the indirect method (patient-reported compliance, which was measured by using study special questionnaire). Three types of adherence were determinedgood (always took all prescribed medications at target doses), moderate (sometimes patients didn’t take one class of medications or took them at suboptimal doses) and poor adherence (patients didn’t take all the prescribed medications).ResultsThe baseline global adherence score was good in 35%, moderate in 63%, and poor in 2% of HF patients. In the group of good physician’s adherence to guideline-recommended therapy 114 patients (51%) had a good adherence, 95 patients (42%) - moderate adherence and only 15 patients (7%) had poor adherence. In the group of moderate physician’s adherence only 88 patients (22%) took medications as prescribed, 266 patients (66%) demonstrated moderate compliance and 44 patients (12%) didn’t take all prescribed medications. After 12 months of follow-up the rates of HF re-hospitalizations were significantly higher in the groups of various physicians’ adherence, when patients’ adherence was poor (HR 2.34, 95% CI 1.46-3.27, p=0.0001).ConclusionDespite the type of physicians’ adherence, patients with poor adherence to guideline-recommended therapy demonstrated higher rates of HF re-hospitalizations. New educational initiatives for both physicians and patients are required to optimize HF treatment.
