Effects of calcium channel blockers on GDMT prescription and outcomes according to ejection fraction: IN-HF real world data.

BACKGROUND

Dihydropyridine calcium channel blockers (DHP-CCB) are widely used in heart failure (HF), despite the lack of data regarding their safety, especially in patients with reduced ejection fraction (HFrEF). We aimed to evaluate DHP-CCB prescription trends over time, their association with GDMT uptake and related outcomes across the spectrum of EF.

METHODS

We studied outpatients with chronic HF prospectively enrolled in the nationwide observational INHF registry from 1998 to 2022. We used Cox regression methods to analyze all-cause mortality and cardiovascular hospitalization at 1-year according to DHP-CCB exposure, applying inverse probability of treatment weighting (IPTW).

RESULTS

We included 15785 outpatients. 10829 (69 %) had HFrEF, and 4956(31 %) an EF>40 %. Median age was 69; 26.6 % were females. Overall, 1458 patients (9.1 %) received a DHP-CCB. DHP-CCB administration was twice as prevalent in patients with an EF>40 % than in those with HFrEF (13.9 %¦vs 7.1 %, respectively p<0.001). DHP-CCB prescription rates increased over time (p<0.001). Patients who received DHP-CCB were older, more comorbid, had a higher EF, and were less frequently prescribed GDMT than those who were not on DHP-CCB. After multivariable adjustment, using IPTW analysis, DHP-CCB prescription was associated with a higher risk of the outcome in the overall cohort (HR 1.11, 95 % CI 1.09-1.12, p<0.001), among HFrEF patients (HR 1.14, 95 % CI 1.12-1.16, p<0.001), and those with EF>40 % (HR 1.07, 95 % CI 1.04-1.10, p<0.001).

CONCLUSION

DHP-CCB use in HFrEF was associated with less GDMT prescription and worse outcomes. Additionally, DHP-CCB safety needs to be further explored in HFmrEF/HFpEF.