Abstract 8872: Comparative Effectiveness of Dosing of Medical Therapy for Heart Failure: From the CHAMP-HF Registry

Abstract

Introduction: The comparative effectiveness of differing doses of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) on clinical and patient-reported outcomes in US clinical practice is unknown. Methods: This analysis included 4,832 US outpatients with chronic HFrEF in the CHAMP-HF registry with available medication data and no contraindications at baseline. Baseline dosing of ACE inhibitor (ACEI)/ angiotensin II receptor blocker (ARB)/ angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA) therapies were examined. Multivariable models assessed associations between medication dosing and clinical outcomes over 24 months (all-cause mortality, HF hospitalization) and patient-reported outcomes at 12 months (change in Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS]). Results: After adjustment, compared with target dosing, lower dosing was independently associated with higher all-cause mortality for ACEI/ARB/ARNI (overall p<0.001) and beta-blocker therapies (overall p=0.042) (Table) . Lower dosing of ACEI/ARB/ARNI was independently associated with higher risk of HF hospitalization (overall p=0.046), but beta-blocker dosing was not. Target dosing of MRA was not associated with risk of mortality or HF hospitalization. For each GDMT, compared with target dosing, lower dosing was not associated with change in KCCQ-OS at 12 months, with potential exception of worsening KCCQ-OS with lower dosing of ACEI/ARB/ARNI. Conclusions: In this contemporary US outpatient HFrEF registry, target dosing of ACEI/ARB/ARNI and beta-blocker was associated with reduced mortality, and variably associated with other outcomes. MRA dosing was not associated with outcomes. Unmeasured differences between patients receiving differing dosages may explain differences between results seen here compared with randomized trials.