Heart failure medication dosage and survival in women and men seen at outpatient clinics

• Published in: Heart (British Cardiac Society) Vol. 107; no. 21; pp. 1748 - 1755
• Main Authors: Bots, Sophie Heleen, Onland-Moret, N Charlotte, Tulevski, Igor I, van der Harst, Pim, Cramer, Maarten J M, Asselbergs, Folkert W, Somsen, G Aernout, den Ruijter, Hester M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.11.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adrenergic beta-Antagonists - administration & dosage; Aged; Ambulatory Care Facilities - statistics & numerical data; Angiotensin Receptor Antagonists - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Beta blockers; Cardiology; Cardiovascular disease; Cause of Death - trends; Dose-Response Relationship, Drug; Ejection fraction; electronic health records; epidemiology; Female; Follow-Up Studies; Gender differences; Guideline Adherence; Heart failure; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - physiopathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hypertension; Male; Medical prognosis; Mineralocorticoid Receptor Antagonists - administration & dosage; Mortality; Netherlands - epidemiology; Noncitizens; Patients; Population; Prescriptions; Registries; Retrospective Studies; Special Populations; Stroke Volume - physiology; Survival Rate - trends; Variables; Ventricular Function, Left - physiology; Womens health; Netherlands; epidemiology; heart failure; electronic health records
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2021-319229

ObjectiveWomen with heart failure with reduced ejection fraction (HFrEF) may reach optimal treatment effect at half of the guideline-recommended medication dose. This study investigates prescription practice and its relation with survival of patients with HF in daily care.MethodsElectronic health record data from 13 Dutch outpatient cardiology clinics were extracted for HF receiving at least one guideline-recommended HF medication. Dose changes over consecutive prescriptions were modelled using natural cubic splines. Inverse probability-weighted Cox regression was used to assess the relationship between dose (reference≥50% target dose) and all-cause mortality.ResultsThe study population comprised 561 women (29% HFrEF (ejection fraction (EF)<40%), 49% heart failure with preserved ejection fraction (EF≥50%); HFpEF and 615 men (47% and 25%, respectively). During a median follow-up of 3.7 years, 252 patients died (48% women; 167 HFrEF, 84 HFpEF). Nine hundred thirty-four patients (46% women) received ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 795 (48% women) beta blockers and 178 (42% women) mineralocorticoid receptor antagonists (MRAs). In both sexes, the mean target dose across prescriptions was 50% for ACEI/ARBs and beta blockers, and 100% for MRAs. ACEI/ARB dose of <50% was associated with lower mortality in women but not in men with HFrEF. This was not seen in patients with HFpEF. Beta-blocker dose was not associated with all-cause mortality.ConclusionPatients with HF seen in outpatient cardiology clinics receive half of the guideline-recommended medication dose. Lower ACEI/ARB dose was associated with improved survival in women with HFrEF. These results underscore the importance of (re)defining optimal medical therapy for women with HFrEF.