Temporal trends in guideline-recommended medical therapy after an acute heart failure decompensation event: an observational analysis from Generator Heart Failure DataMart
Objectives To evaluate the trend of prescription of the four foundational therapies, and their impact on 30-day urgent re-admissions and all-cause death in patients with heart failure and reduced ejection fraction (HFrEF) following an acute decompensation event.Design Retrospective.Setting One terti...
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/2/e088998.full |
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| author | Antonio Gasbarrini Giuseppe Patti Filippo Crea Giovanni Scambia Domenico D'Amario Vincenzo Valentini Gianluigi Savarese Alfredo Cesario Jacopo Lenkowicz Stefano Patarnello Renzo Laborante Agni Delvinioti Andrada Mihaela Tudor Chiara Iacomini Antonio Iaconelli Donato Antonio Paglianiti Mattia Galli Daniele Rodolico Attilio Restivo Giuseppe Ciliberti Gaetano Rizzo Emiliano Bianchini Matteo Busti Luca Sensini |
| author_facet | Antonio Gasbarrini Giuseppe Patti Filippo Crea Giovanni Scambia Domenico D'Amario Vincenzo Valentini Gianluigi Savarese Alfredo Cesario Jacopo Lenkowicz Stefano Patarnello Renzo Laborante Agni Delvinioti Andrada Mihaela Tudor Chiara Iacomini Antonio Iaconelli Donato Antonio Paglianiti Mattia Galli Daniele Rodolico Attilio Restivo Giuseppe Ciliberti Gaetano Rizzo Emiliano Bianchini Matteo Busti Luca Sensini |
| author_sort | Antonio Gasbarrini |
| collection | DOAJ |
| description | Objectives To evaluate the trend of prescription of the four foundational therapies, and their impact on 30-day urgent re-admissions and all-cause death in patients with heart failure and reduced ejection fraction (HFrEF) following an acute decompensation event.Design Retrospective.Setting One tertiary referral centre.Participants 999 consecutively patients admitted with a primary diagnosis of HFrEF between January 2020 and June 2023 were identified through a validated, high‐performance technology infrastructure based on artificial intelligence. The entire cohort was divided into three time periods based on two time points: September 2021 (ie, the release of the latest European guidelines) and January 2022 (ie, reimbursement for sodium-glucose cotransporter 2 (SGLT2) inhibitors).Primary and secondary outcome measures Trends and predictors of the prescription of each of the four foundational therapies and of the composite of all-cause death and rehospitalisation for urgent causes at 30 days.Results Among the 999 included patients, β-blockers were prescribed in 93% of patients, ACE inhibitor (ACEi)/angiotensin receptor blocker (ARB)/angiotensin–neprilysin receptor inhibitor (ARNi) in 73%, mineralocorticoid receptor antagonist in 30% and SGLT2 inhibitors in 18%. Over time, an increase in the prescription rate occurred only for SGLT2 inhibitors (3% vs 10% vs 32%, p<0.001), whereas the rate of the composite of all-cause death and rehospitalisation for urgent causes at 30 days remained stable (9.9% vs 10.3% vs 8.4%; p=ns). In multivariate analysis, the use of ACEi/ARB/ARNi was associated with a lower risk of 30-day all-cause death and urgent rehospitalisation (adjusted OR 0.38; 95% CI 0.24 to 0.59; p<0.01). Conversely, the prescription of furosemide at discharge (adjusted OR 2.25; 95% CI 95% 1.29 to 3.94; p<0.01) and a previous genitourinary infection (adjusted OR 4.02; 95% CI 1.67 to 9.68; p<0.01) were associated with higher risk of 30-day all-cause death and urgent rehospitalisation.Conclusions In our study, early adoption of guideline-recommended medical therapy is still limited, with a significant rise in SGLT2i prescriptions after January 2022 and a lower risk of the composite of all-cause death and urgent readmissions at 30 days restricted to the use of ACEi/ARB/ARNi. |
| format | Article |
| id | doaj-art-29cef6d031054732882d0b738f920b22 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-29cef6d031054732882d0b738f920b222025-02-09T03:40:15ZengBMJ Publishing GroupBMJ Open2044-60552025-02-0115210.1136/bmjopen-2024-088998Temporal trends in guideline-recommended medical therapy after an acute heart failure decompensation event: an observational analysis from Generator Heart Failure DataMartAntonio Gasbarrini0Giuseppe Patti1Filippo Crea2Giovanni Scambia3Domenico D'Amario4Vincenzo Valentini5Gianluigi Savarese6Alfredo Cesario7Jacopo Lenkowicz8Stefano Patarnello9Renzo Laborante10Agni Delvinioti11Andrada Mihaela Tudor12Chiara Iacomini13Antonio Iaconelli14Donato Antonio Paglianiti15Mattia Galli16Daniele Rodolico17Attilio Restivo18Giuseppe Ciliberti19Gaetano Rizzo20Emiliano Bianchini21Matteo Busti22Luca Sensini23Department of Medical and Surgical Sciences, IRCCS `A Gemelli` University Polyclinic Foundation, Rome, ItalyDipartimento di MedicinaTraslazionale, Università del Piemonte Orientale, Novara, ItalyFondazione Policlinico Universitario A Gemelli IRCCS, Rome, ItalyFondazione Policlinico Universitario A Gemelli IRCCS, Rome, ItalyDipartimento di MedicinaTraslazionale, Università del Piemonte Orientale, Novara, ItalyDepartment of Bioimaging Radiation Oncology and Hematology, Università Cattolica S, Roma, ItalyDepartment of Clinical Science and Education, Södersjukhuset, Södersjukhuset and Karolinska Institutet, Stockholm, SwedenGemelli Digital Medicine & Health Srl, Roma, ItalyFondazione Policlinico Universitario A Gemelli IRCCS, Rome, ItalyFondazione Policlinico Universitario A Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, ItalyFondazione Policlinico Universitario A Gemelli IRCCS, Rome, ItalyDepartment of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Catholic University of the Sacred Heart, Rome, ItalyFondazione Policlinico Universitario A Gemelli IRCCS, Rome, ItalyFondazione Policlinico Universitario A Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, ItalyDipartimento di MedicinaTraslazionale, Università del Piemonte Orientale, Novara, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, ItalyObjectives To evaluate the trend of prescription of the four foundational therapies, and their impact on 30-day urgent re-admissions and all-cause death in patients with heart failure and reduced ejection fraction (HFrEF) following an acute decompensation event.Design Retrospective.Setting One tertiary referral centre.Participants 999 consecutively patients admitted with a primary diagnosis of HFrEF between January 2020 and June 2023 were identified through a validated, high‐performance technology infrastructure based on artificial intelligence. The entire cohort was divided into three time periods based on two time points: September 2021 (ie, the release of the latest European guidelines) and January 2022 (ie, reimbursement for sodium-glucose cotransporter 2 (SGLT2) inhibitors).Primary and secondary outcome measures Trends and predictors of the prescription of each of the four foundational therapies and of the composite of all-cause death and rehospitalisation for urgent causes at 30 days.Results Among the 999 included patients, β-blockers were prescribed in 93% of patients, ACE inhibitor (ACEi)/angiotensin receptor blocker (ARB)/angiotensin–neprilysin receptor inhibitor (ARNi) in 73%, mineralocorticoid receptor antagonist in 30% and SGLT2 inhibitors in 18%. Over time, an increase in the prescription rate occurred only for SGLT2 inhibitors (3% vs 10% vs 32%, p<0.001), whereas the rate of the composite of all-cause death and rehospitalisation for urgent causes at 30 days remained stable (9.9% vs 10.3% vs 8.4%; p=ns). In multivariate analysis, the use of ACEi/ARB/ARNi was associated with a lower risk of 30-day all-cause death and urgent rehospitalisation (adjusted OR 0.38; 95% CI 0.24 to 0.59; p<0.01). Conversely, the prescription of furosemide at discharge (adjusted OR 2.25; 95% CI 95% 1.29 to 3.94; p<0.01) and a previous genitourinary infection (adjusted OR 4.02; 95% CI 1.67 to 9.68; p<0.01) were associated with higher risk of 30-day all-cause death and urgent rehospitalisation.Conclusions In our study, early adoption of guideline-recommended medical therapy is still limited, with a significant rise in SGLT2i prescriptions after January 2022 and a lower risk of the composite of all-cause death and urgent readmissions at 30 days restricted to the use of ACEi/ARB/ARNi.https://bmjopen.bmj.com/content/15/2/e088998.full |
| spellingShingle | Antonio Gasbarrini Giuseppe Patti Filippo Crea Giovanni Scambia Domenico D'Amario Vincenzo Valentini Gianluigi Savarese Alfredo Cesario Jacopo Lenkowicz Stefano Patarnello Renzo Laborante Agni Delvinioti Andrada Mihaela Tudor Chiara Iacomini Antonio Iaconelli Donato Antonio Paglianiti Mattia Galli Daniele Rodolico Attilio Restivo Giuseppe Ciliberti Gaetano Rizzo Emiliano Bianchini Matteo Busti Luca Sensini Temporal trends in guideline-recommended medical therapy after an acute heart failure decompensation event: an observational analysis from Generator Heart Failure DataMart BMJ Open |
| title | Temporal trends in guideline-recommended medical therapy after an acute heart failure decompensation event: an observational analysis from Generator Heart Failure DataMart |
| title_full | Temporal trends in guideline-recommended medical therapy after an acute heart failure decompensation event: an observational analysis from Generator Heart Failure DataMart |
| title_fullStr | Temporal trends in guideline-recommended medical therapy after an acute heart failure decompensation event: an observational analysis from Generator Heart Failure DataMart |
| title_full_unstemmed | Temporal trends in guideline-recommended medical therapy after an acute heart failure decompensation event: an observational analysis from Generator Heart Failure DataMart |
| title_short | Temporal trends in guideline-recommended medical therapy after an acute heart failure decompensation event: an observational analysis from Generator Heart Failure DataMart |
| title_sort | temporal trends in guideline recommended medical therapy after an acute heart failure decompensation event an observational analysis from generator heart failure datamart |
| url | https://bmjopen.bmj.com/content/15/2/e088998.full |
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