Therapy modifications during hospitalization in patients with chronic heart failure

• HF pharmacotherapy adherence to the guidelines was assessed at admission and discharge.
• Drug therapy in patients with HF did not improve significantly during hospitalization.
• Only 12% of patients with LVSD were discharged with all 3 guideline-recommended HF drugs.
• The LVSD patients with no HF drugs had worse survival than patients with 1–3 drugs.
• The PLVEF patients had better survival than the LVSD patients with no HF drugs.

Background: Guidelines on suggested pharmacological treatments for heart failure (HF) are not optimally implemented in clinical practice and whether pharmacotherapy adjustment actually happens in daily practice is largely unknown. We aimed to investigate pharmacotherapy modifications during hospitalization.Methods: This was a prospective observational survey where all admissions were screened for HF; 210 patients were included. The guideline adherence index (GAI) and modified GAI (mGAI, if ≥ 50% of target dose) were used to grade the pharmacotherapy.Results: Among 198 patients discharged alive (mean age 77 years, 51% male), 49% had preserved left ventricular ejection fraction (PLVEF) and 30% had left ventricular systolic dysfunction (LVSD); the echocardiography report was unavailable for 21%. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists were prescribed to 78%, 58% and 20% of patients on admission and 72%, 65% and 23% at discharge, respectively. Overall, 14% of patients met GAI-3, but at discharge only 7% met mGAI-3. One of the key drugs was stopped or down-titrated in 27%. During follow-up, 21% of patients died (25% with LVSD). Patients with LVSD discharged with at least one HF drug had a lower risk of death than patients with none (HR = 0.142, 95% CI = 0.029–0.683, p = 0.015). Patients with PLVEF had better prognosis than LVSD patients when no HF drugs were prescribed at discharge (HR = 0.075, 95% CI = 0.009–0.627, p = 0.017).Conclusions: The pharmacotherapy of HF patients did not improve significantly during hospitalization, remaining suboptimal. Treatment with key drugs was terminated or reduced in a significant proportion of patients, mostly without specific written justification.

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