Medical Inertia in the Optimization of Heart Failure Treatment after Discharge and its Relationship to Outcome

Abstract

Background: After discharge, patients with Acute Heart Failure (AHF) have a high risk of early re-admission and death. Many patients are discharged early before treatment has been optimized. By using a multicenter cohort of AHF patients, we analyzed changes in evidence-based HF medication between admission, discharge and early follow-up as well as their links to mortality. Methods: Clinical data and medications were collected during hospitalization. Changes in medication during the 3 months following discharge as well as the rate of all-cause mortality at one year were analyzed. Results: Among survivors at 3 months, 275 patients with LVEF ≤ 40% were included (age 72 ± 14 y). Between admission and discharge, usage of angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) and beta blocker (BB) increased by 19 to 20% and MRA by 8%. At discharge, ACE-I or ARB were prescribed in 80% of cases with the mean dose reaching 36 ± 31% of target dose, BB in 70% with the mean dose of 27 ± 51% of the target dose, mineraloreceptor antagonists (MRA) were prescribed in 23% and diuretics in 88% cases. Three months after discharge, there were few changes in medications. Start in ACE-I or ARB, beta-blockers and MRA was performed in 3 to 7% while cessation was performed in 5 to 6% cases. Changes in doses were observed in about 25% cases. usage of BB and Ace ORARB >/ % of target dose at 3 months shows a tendency to deusage montality [ HR=5,2999;95%ic1,7369-16-1722; p=0,0635]. Conclusion: Our data points out inertia in optimization of evidence-based HF medications after discharge and focus on potential explanations of such inertia. Medical ineatia have a potential impaction on outcomein heart failure.