Optimization of heart failure medication after cardiac resynchronization therapy and the impact on long-term survival

Christoffer Tobias Witt, Mads Brix Kronborg, Ellen Aagaard Nohr, Peter Thomas Mortensen, Christian Gerdes, Jens Cosedis Nielsen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

AIMS: Treatment with evidence-based heart failure (HF) medication reduces morbidity and mortality, yet they remain underused and underdosed. Cardiac resynchronization therapy (CRT) improves haemodynamics, and might allow for optimization of HF medication. We analysed treatment with HF medication after CRT implantation, long-term adherence to this treatment, and its association with patient survival.

METHODS AND RESULTS: This observational study included 826 consecutive patients who received a CRT device at a tertiary centre. Data were obtained from patient files and prescription data from the Danish National Prescription Registry. Doses are expressed as percentages of target doses. We used Cox proportional hazard model to compute adjusted hazard ratios (aHRs) for survival with 95% confidence intervals (CIs), adjusted for potential confounders. During the median (quartiles) follow-up of 4.4 (3.0-6.7) years, 324 patients died. Daily doses of beta-blocker (BB) (53 (27-90) vs. 43 (22-75)%; P < 0.001) and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) (78 (45-100) vs. 74 (44-97)%; P = 0.02) had increased after 6-month follow-up compared with pre-implantation doses. After 4 years, adherence was 95% to BB and 94% to ACEi/ARB. Treatments with low (≤50%) and high (>50%) doses were associated with prolonged survival for BB (low: aHR 0.65 (0.47-0.90); P = 0.009, and high: aHR 0.50 (0.35-0.70); P < 0.001) and for ACEi/ARB (low: aHR 0.68 (0.46-1.00); P = 0.05, and high: aHR 0.55 (0.38-0.80); P = 0.002).

CONCLUSION: After CRT implantation, optimization of HF treatment is possible, and long-term adherence to HF medication remains high. Higher doses of BB and ACEi/ARB were associated with prolonged survival.

OriginalsprogEngelsk
TidsskriftEuropean Heart Journal - Cardiovascular Pharmacotherapy
Vol/bind1
Udgave nummer3
Sider (fra-til)182-8
ISSN2055-6837
DOI
StatusUdgivet - 2015

Fingeraftryk

Cardiac Resynchronization Therapy
Prescriptions
Cardiac Resynchronization Therapy Devices
Information Storage and Retrieval
Proportional Hazards Models
Registries
Confidence Intervals

Citer dette

Witt, Christoffer Tobias ; Kronborg, Mads Brix ; Nohr, Ellen Aagaard ; Mortensen, Peter Thomas ; Gerdes, Christian ; Nielsen, Jens Cosedis. / Optimization of heart failure medication after cardiac resynchronization therapy and the impact on long-term survival. I: European Heart Journal - Cardiovascular Pharmacotherapy. 2015 ; Bind 1, Nr. 3. s. 182-8.
@article{1182bbd32c3c414391e17bd89f742f4d,
title = "Optimization of heart failure medication after cardiac resynchronization therapy and the impact on long-term survival",
abstract = "AIMS: Treatment with evidence-based heart failure (HF) medication reduces morbidity and mortality, yet they remain underused and underdosed. Cardiac resynchronization therapy (CRT) improves haemodynamics, and might allow for optimization of HF medication. We analysed treatment with HF medication after CRT implantation, long-term adherence to this treatment, and its association with patient survival.METHODS AND RESULTS: This observational study included 826 consecutive patients who received a CRT device at a tertiary centre. Data were obtained from patient files and prescription data from the Danish National Prescription Registry. Doses are expressed as percentages of target doses. We used Cox proportional hazard model to compute adjusted hazard ratios (aHRs) for survival with 95{\%} confidence intervals (CIs), adjusted for potential confounders. During the median (quartiles) follow-up of 4.4 (3.0-6.7) years, 324 patients died. Daily doses of beta-blocker (BB) (53 (27-90) vs. 43 (22-75){\%}; P < 0.001) and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) (78 (45-100) vs. 74 (44-97){\%}; P = 0.02) had increased after 6-month follow-up compared with pre-implantation doses. After 4 years, adherence was 95{\%} to BB and 94{\%} to ACEi/ARB. Treatments with low (≤50{\%}) and high (>50{\%}) doses were associated with prolonged survival for BB (low: aHR 0.65 (0.47-0.90); P = 0.009, and high: aHR 0.50 (0.35-0.70); P < 0.001) and for ACEi/ARB (low: aHR 0.68 (0.46-1.00); P = 0.05, and high: aHR 0.55 (0.38-0.80); P = 0.002).CONCLUSION: After CRT implantation, optimization of HF treatment is possible, and long-term adherence to HF medication remains high. Higher doses of BB and ACEi/ARB were associated with prolonged survival.",
keywords = "Journal Article",
author = "Witt, {Christoffer Tobias} and Kronborg, {Mads Brix} and Nohr, {Ellen Aagaard} and Mortensen, {Peter Thomas} and Christian Gerdes and Nielsen, {Jens Cosedis}",
note = "Published on behalf of the European Society of Cardiology. All rights reserved. {\circledC} The Author 2015. For permissions please email: journals.permissions@oup.com.",
year = "2015",
doi = "10.1093/ehjcvp/pvv016",
language = "English",
volume = "1",
pages = "182--8",
journal = "European Heart Journal - Cardiovascular Pharmacotherapy",
issn = "2055-6837",
publisher = "Heinemann",
number = "3",

}

Optimization of heart failure medication after cardiac resynchronization therapy and the impact on long-term survival. / Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard; Mortensen, Peter Thomas; Gerdes, Christian; Nielsen, Jens Cosedis.

I: European Heart Journal - Cardiovascular Pharmacotherapy, Bind 1, Nr. 3, 2015, s. 182-8.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Optimization of heart failure medication after cardiac resynchronization therapy and the impact on long-term survival

AU - Witt, Christoffer Tobias

AU - Kronborg, Mads Brix

AU - Nohr, Ellen Aagaard

AU - Mortensen, Peter Thomas

AU - Gerdes, Christian

AU - Nielsen, Jens Cosedis

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

PY - 2015

Y1 - 2015

N2 - AIMS: Treatment with evidence-based heart failure (HF) medication reduces morbidity and mortality, yet they remain underused and underdosed. Cardiac resynchronization therapy (CRT) improves haemodynamics, and might allow for optimization of HF medication. We analysed treatment with HF medication after CRT implantation, long-term adherence to this treatment, and its association with patient survival.METHODS AND RESULTS: This observational study included 826 consecutive patients who received a CRT device at a tertiary centre. Data were obtained from patient files and prescription data from the Danish National Prescription Registry. Doses are expressed as percentages of target doses. We used Cox proportional hazard model to compute adjusted hazard ratios (aHRs) for survival with 95% confidence intervals (CIs), adjusted for potential confounders. During the median (quartiles) follow-up of 4.4 (3.0-6.7) years, 324 patients died. Daily doses of beta-blocker (BB) (53 (27-90) vs. 43 (22-75)%; P < 0.001) and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) (78 (45-100) vs. 74 (44-97)%; P = 0.02) had increased after 6-month follow-up compared with pre-implantation doses. After 4 years, adherence was 95% to BB and 94% to ACEi/ARB. Treatments with low (≤50%) and high (>50%) doses were associated with prolonged survival for BB (low: aHR 0.65 (0.47-0.90); P = 0.009, and high: aHR 0.50 (0.35-0.70); P < 0.001) and for ACEi/ARB (low: aHR 0.68 (0.46-1.00); P = 0.05, and high: aHR 0.55 (0.38-0.80); P = 0.002).CONCLUSION: After CRT implantation, optimization of HF treatment is possible, and long-term adherence to HF medication remains high. Higher doses of BB and ACEi/ARB were associated with prolonged survival.

AB - AIMS: Treatment with evidence-based heart failure (HF) medication reduces morbidity and mortality, yet they remain underused and underdosed. Cardiac resynchronization therapy (CRT) improves haemodynamics, and might allow for optimization of HF medication. We analysed treatment with HF medication after CRT implantation, long-term adherence to this treatment, and its association with patient survival.METHODS AND RESULTS: This observational study included 826 consecutive patients who received a CRT device at a tertiary centre. Data were obtained from patient files and prescription data from the Danish National Prescription Registry. Doses are expressed as percentages of target doses. We used Cox proportional hazard model to compute adjusted hazard ratios (aHRs) for survival with 95% confidence intervals (CIs), adjusted for potential confounders. During the median (quartiles) follow-up of 4.4 (3.0-6.7) years, 324 patients died. Daily doses of beta-blocker (BB) (53 (27-90) vs. 43 (22-75)%; P < 0.001) and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) (78 (45-100) vs. 74 (44-97)%; P = 0.02) had increased after 6-month follow-up compared with pre-implantation doses. After 4 years, adherence was 95% to BB and 94% to ACEi/ARB. Treatments with low (≤50%) and high (>50%) doses were associated with prolonged survival for BB (low: aHR 0.65 (0.47-0.90); P = 0.009, and high: aHR 0.50 (0.35-0.70); P < 0.001) and for ACEi/ARB (low: aHR 0.68 (0.46-1.00); P = 0.05, and high: aHR 0.55 (0.38-0.80); P = 0.002).CONCLUSION: After CRT implantation, optimization of HF treatment is possible, and long-term adherence to HF medication remains high. Higher doses of BB and ACEi/ARB were associated with prolonged survival.

KW - Journal Article

U2 - 10.1093/ehjcvp/pvv016

DO - 10.1093/ehjcvp/pvv016

M3 - Journal article

C2 - 27533993

VL - 1

SP - 182

EP - 188

JO - European Heart Journal - Cardiovascular Pharmacotherapy

JF - European Heart Journal - Cardiovascular Pharmacotherapy

SN - 2055-6837

IS - 3

ER -