Pharmacotherapy treatment patterns at hospital discharge and clinical outcomes among patients with heart failure with reduced ejection fraction

Yuttana Wongsalap; Duangkamon Poolpun; Konrapee Keawhai; Napusson Kitpluem; Parichat Pansiri; Siriluck Malaimat; Vichai Senthong; Kirati Kengkla

doi:10.1002/cdt3.59

Pharmacotherapy treatment patterns at hospital discharge and clinical outcomes among patients with heart failure with reduced ejection fraction

Chronic Dis Transl Med. 2023 Feb 8;9(2):154-163. doi: 10.1002/cdt3.59. eCollection 2023 Jun.

Authors

Yuttana Wongsalap^{1

2}, Duangkamon Poolpun³, Konrapee Keawhai¹, Napusson Kitpluem¹, Parichat Pansiri¹, Siriluck Malaimat¹, Vichai Senthong⁴, Kirati Kengkla^{1

5}

Affiliations

¹ Division of Clinical Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences University of Phayao Phayao Thailand.
² Unit of Excellence on Pharmacogenomic Pharmacokinetic and Pharmacotherapeutic Researches (UP-PER), School of Pharmaceutical Sciences University of Phayao Phayao Thailand.
³ Department of Pharmacy Buddhachinaraj Hospital Phitsanulok Thailand.
⁴ Cardiovascular Unit, Department of Medicine, Faculty of Medicine Khon Kaen University Khon Kaen Thailand.
⁵ Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences University of Phayao Phayao Thailand.

Abstract

Background: This study aimed to assess the prescribing patterns of evidence-based pharmacotherapy and their association with clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) in Thailand.

Methods: A retrospective cohort study of patients with HFrEF was conducted. Treatment with a β-blocker and renin-angiotensin system inhibitors (RASIs) with or without mineralocorticoid receptor antagonists (MRAs) at discharge was regarded as guideline-directed medical therapy (GDMT). All others were considered non-GDMT. The primary endpoint was the composite of all-cause mortality or heart failure (HF) rehospitalization. Inverse-probability-treatment-weighted adjusted Cox proportional hazard models were used to examine the treatment effects.

Results: In total, 653 patients with HFrEF (mean age 64.1 ± 14.3 years; 55.9% male) were included. GDMT with β-blockers and RASIs with or without MRAs was prescribed at a rate of 35.4%. During a median of 1-year follow-up, 167 patients (27.5%) had a composite event, 81 patients (13.3%) had all-cause mortality, and 109 patients (18.0%) had HF rehospitalization. Patients treated with GDMT at discharge showed significantly lower rates of the primary endpoint (adjusted hazard ratio [HR] 0.63; 95% CI 0.44-0.89; p = 0.009) compared with patients who did not receive GDMT. The use of GDMT was also associated with a significantly lower risk of all-cause mortality (adjusted HR 0.59; 95% CI 0.36-0.98; p = 0.045) and HF rehospitalization (adjusted HR 0.65; 95% CI 0.43-0.96; p = 0.031).

Conclusions: For HFrEF treatment, GDMT initiation at hospital discharge was associated with a significantly reduced risk of all-cause mortality and HF rehospitalization. Nevertheless, prescribing GDMT remains underused, and it could be encouraged to improve HF outcomes in real-world settings.

Keywords: HFrEF; mortality; real‐world evidence; rehospitalization; treatment patterns.