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Medical Inertia in the Optimization of Heart Failure Treatment after Discharge and its Relationship to Outcome

Berthelot E, Eicher JC, Salvat M, Seronde MF, de Groote, Jondeau G, Galinier M, Roul G, Donal E, Damy T, Jourdain P, Bauer F, Isnard R, Trochu JN, Logeart D and On behalf of Gicc-HF.

Background: After discharge, patients with Acute Heart Failure (AHF) have a high risk of early re-admission and death. Many patients are discharged early before treatment has been optimized. By using a multicenter cohort of AHF patients, we analyzed changes in evidence-based HF medication between admission, discharge and early follow-up as well as their links to mortality.
Methods: Clinical data and medications were collected during hospitalization. Changes in medication during the 3 months following discharge as well as the rate of all-cause mortality at one year were analyzed.
Results: Among survivors at 3 months, 275 patients with LVEF ≤ 40% were included (age 72 ± 14 y). Between admission and discharge, usage of angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) and beta blocker (BB) increased by 19 to 20% and MRA by 8%. At discharge, ACE-I or ARB were prescribed in 80% of cases with the mean dose reaching 36 ± 31% of target dose, BB in 70% with the mean dose of 27 ± 51% of the target dose, mineraloreceptor antagonists (MRA) were prescribed in 23% and diuretics in 88% cases. Three months after discharge, there were few changes in medications. Start in ACE-I or ARB, beta-blockers and MRA was performed in 3 to 7% while cessation was performed in 5 to 6% cases. Changes in doses were observed in about 25% cases. usage of BB and Ace ORARB >/ % of target dose at 3 months shows a tendency to deusage montality [ HR=5,2999;95%ic1,7369-16-1722; p=0,0635].
Conclusion: Our data points out inertia in optimization of evidence-based HF medications after discharge and focus on potential explanations of such inertia. Medical ineatia have a potential impaction on outcomein heart failure.