Acta Cardiologica Sinica · 2025
Early Initiation of Guideline-Directed Medical Therapy Improves Outcomes in Heart Failure with Reduced Ejection Fraction Patients without Significant Risk of Nephrotoxicity.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Huang Chi-Cheng, Tzeng Bing-Hsiean, Tsai Hao-Yuan, Lee Chien-Lin, Huang Shan-Hui, Yeh Yen-Ting, Hsu Jung-Cheng, Chien Chung-Liang, Wu Yen-Wen
Аннотация
BACKGROUND: Current evidence supports the early initiation of all guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF), but clinical inertia persists in real-world practice.
METHODS: Clinical data of 343 HFrEF patients hospitalized from January 2018 to December 2019 were collected, and they were followed for at least 3 years. We analyzed the benefits of optimizing GDMT at hospital discharge, the reasons for underprescription of GDMT, and factors associated with different outcomes after multivariate adjustments.
RESULTS: Starting at least 3 pillars of GDMT at hospital discharge significantly reduced the risks of all-cause mortality, cardiovascular (CV) death, and heart failure hospitalization (hazard ratio = 0.22, 0.21, 0.28, respectively; all p < 0.001). Renal impairment was the major factor associated with the non-optimization of GDMT, and 78.4% of patients receiving fewer than 3 pillars of GDMT had a baseline chronic kidney disease stage 3-5. However, the prescription of GDMT was not associated with any observable risk of adverse renal outcomes.
CONCLUSIONS: This study demonstrated the CV benefits and safety regarding renal outcomes with the early initiation of GDMT in HFrEF patients. Efforts should be made to address the disparity between evidence-based medicine and daily practice.
METHODS: Clinical data of 343 HFrEF patients hospitalized from January 2018 to December 2019 were collected, and they were followed for at least 3 years. We analyzed the benefits of optimizing GDMT at hospital discharge, the reasons for underprescription of GDMT, and factors associated with different outcomes after multivariate adjustments.
RESULTS: Starting at least 3 pillars of GDMT at hospital discharge significantly reduced the risks of all-cause mortality, cardiovascular (CV) death, and heart failure hospitalization (hazard ratio = 0.22, 0.21, 0.28, respectively; all p < 0.001). Renal impairment was the major factor associated with the non-optimization of GDMT, and 78.4% of patients receiving fewer than 3 pillars of GDMT had a baseline chronic kidney disease stage 3-5. However, the prescription of GDMT was not associated with any observable risk of adverse renal outcomes.
CONCLUSIONS: This study demonstrated the CV benefits and safety regarding renal outcomes with the early initiation of GDMT in HFrEF patients. Efforts should be made to address the disparity between evidence-based medicine and daily practice.