Polypharmacy and Optimization of Guideline-Directed Medical Therapy in Heart Failure: The GUIDE-IT Trial.
JACC Heart Fail
; 11(11): 1507-1517, 2023 11.
Article
em En
| MEDLINE
| ID: mdl-37115133
ABSTRACT
BACKGROUND:
Polypharmacy is common among patients with heart failure with reduced ejection fraction (HFrEF). However, its impact on the use of optimal guideline-directed medical therapy (GDMT) is not well established.OBJECTIVES:
This study sought to evaluate the association between polypharmacy and odds of receiving optimal GDMT over time among patients with HFrEF.METHODS:
The authors conducted a post hoc analysis of the GUIDE-IT (Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment) trial. Polypharmacy was defined as receiving ≥5 medications (excluding HFrEF GDMT) at baseline. The outcome of interest was optimal triple therapy GDMT (concurrent administration of a renin-angiotensin-aldosterone blocker and beta-blocker at 50% of the target dose and a mineralocorticoid receptor antagonist at any dose) achieved over the 12-month follow-up. Multivariable adjusted mixed-effect logistic regression models with multiplicative interaction terms (time × polypharmacy) were constructed to evaluate how polypharmacy at baseline modified the odds of achieving optimal GDMT on follow-up.RESULTS:
The study included 891 participants with HFrEF. The median number of non-GDMT medications at baseline was 4 (IQR 3-6), with 414 (46.5%) prescribed ≥5 and identified as being on polypharmacy. The proportion of participants who achieved optimal GDMT at the end of the 12-month follow-up was lower with vs without polypharmacy at baseline (15% vs 19%, respectively). In adjusted mixed models, the odds of achieving optimal GDMT over time were modified by baseline polypharmacy status (P for interaction < 0.001). Patients without polypharmacy at baseline had increased odds of achieving GDMT (OR 1.16 [95% CI 1.12-1.21] per 1-month increase; P < 0.001) but not patients with polypharmacy (OR 1.01 [95% CI 0.96-1.06)] per 1-month increase).CONCLUSIONS:
Patients with HFrEF who are on non-GDMT polypharmacy have lower odds of achieving optimal GDMT on follow-up.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Disfunção Ventricular Esquerda
/
Insuficiência Cardíaca
Tipo de estudo:
Guideline
Limite:
Humans
Idioma:
En
Revista:
JACC Heart Fail
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos