Heart failure treatment up-titration and outcome and age: an analysis of BIOSTAT-CHF

Mordi, I. R. et al. (2020) Heart failure treatment up-titration and outcome and age: an analysis of BIOSTAT-CHF. European Journal of Heart Failure, (doi: 10.1002/ejhf.1799) (PMID:32216000) (Early Online Publication)

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Abstract

Aims: Several studies have shown that older patients with heart failure with reduced ejection fraction (HFrEF) are undertreated. The aim of this study was to evaluate the association of up‐titration of angiotensin‐converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) and beta‐blockers on outcome across the age spectrum in HFrEF patients. Methods and results: We analysed HFrEF patients on sub‐optimal doses of ACEI/ARB and/or beta‐blockers from the BIOSTAT‐CHF study stratified by age. Patients underwent a 3‐month up‐titration period. We used inverse probability weighting to adjust for the likelihood of successful up‐titration to determine the association of achieved dose with mortality and/or heart failure hospitalisation, testing for an interaction with age. Over a median follow‐up of 21 months in 1720 HFrEF patients (76.5% male, mean age 67 years), the primary outcome occurred in 558 patients. Increased percentage of target dose of ACEI/ARB and beta‐blocker achieved at 3 months were both significantly associated with reduced incidence of the primary outcome, [ACEI‐ARB: hazard ratio (HR) per 12.5% increase in dose: 0.92, 95% confidence interval (CI) 0.91–0.94, P < 0.001; beta‐blocker: HR 0.98, 95% CI 0.95–1.00, P = 0.046], with a significant interaction with age seen for beta‐blockers but not ACEI/ARB (P = 0.034 and P = 0.22, respectively). Conclusions: Achieving higher doses of ACEI/ARB was associated with improved outcome regardless of age. However, achieving higher doses of beta‐blockers was only associated with improved outcome in younger, but not in older patients.

Item Type:Articles
Additional Information:This project was funded by a grant from the European Commission: FP7-242209-BIOSTAT-CHF. IRM is supported by a NHS Education for Scotland/Chief Scientist Office Postdoctoral Clinical Lectureship (PCL/17/07).
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Mordi, Dr Ify
Authors: Mordi, I. R., Ouwerkerk, W., Anker, S. D., Cleland, J. G., Dickstein, K., Metra, M., Ng, L. L., Samani, N. J., van Veldhuisen, D. J., Zannad, F., Voors, A. A., and Lang, C. C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:25 March 2020
Copyright Holders:Copyright © 2020 European Society of Cardiology
First Published:First published in European Journal of Heart Failure 2020
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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