Optimal Medical Therapy and Outcomes Among Patients With Chronic Heart Failure With Reduced Ejection Fraction.
JACC Heart Fail
; 2024 Jul 25.
Article
in En
| MEDLINE
| ID: mdl-39115518
ABSTRACT
BACKGROUND:
Optimal medical therapy (OMT) scoring may stratify clinical risk in real-world chronic heart failure with reduced ejection fraction (HFrEF) by integrating use and dosing of guideline-directed medical therapy (GDMT) for HFrEF.OBJECTIVES:
The purpose of this study was to characterize patients and associated long-term clinical outcomes by OMT score-derived treatment groups.METHODS:
CHAMP-HF (Change the Management of Patients with Heart Failure) included U.S. outpatients with chronic HFrEF receiving ≥1 GDMT. OMT subgroups were defined as suboptimal (score <3), acceptable (score = 3), and optimal (score ≥4) by baseline use and dose of GDMT, as proposed by the HF Collaboratory consortium. Cox proportional hazard analyses were used to assess for all-cause and cardiovascular death across subgroups, after adjusting for demographic and clinical covariates.RESULTS:
The authors studied 4,582 participants enrolled in CHAMP-HF with available 2-year follow-up. Median age was 68 years, 1,327 (29%) were women, and 2,842 (62%) were White, non-Hispanic. Median OMT score across the population was 4 (Q1-Q3 2-5), and 1,628 (35%) had suboptimal, 665 (14%) had acceptable, and 2,289 (50%) had optimal therapy. Participants with optimal treatment were younger, had higher annual household income, and were enrolled from practices with dedicated HF clinics (all P < 0.001) than participants with acceptable or suboptimal treatment. Participants with optimal treatment had lower all-cause death (adjusted HR 0.77; 95% CI 0.64-0.92) and cardiovascular death (adjusted HR 0.79; 95% CI 0.65-0.96) than those with suboptimal treatment.CONCLUSIONS:
Across a large cohort of chronic ambulatory HFrEF, OMT scores stratified risk of all-cause and cardiovascular death.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
JACC Heart Fail
Year:
2024
Document type:
Article
Affiliation country:
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