SPC365

Prognosis significance of reaching optimal medical therapy in patients with heart failure- a real life overview

Session: Posters - D. Heart Failure
Speaker: José João Monteiro

Congress: CPC 2021
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Posters
FP Number: ---
Authors: José João Monteiro; Pedro Rocha Carvalho; Fernando Fonseca Gonçalves; José João Cardoso Dias Monteiro; Sara Borges; Jose Pedro Guimaraes; Miguel Moz; Marta Bernardo; Catarina Ribeiro Carvalho; Helder Ribeiro; Ilidio Moreira; Joaquim Manuel Chemba

<p><strong><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Introduction</span></span></span></strong></p>

<p><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Heart failure remains a condition with an ominous prognosis, in spite of a growing number therapeutic options. So, it is important to elucidate which drugs and respective doses can impact survival outcomes.</span></span></span></p>

<p><strong><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Objective</span></span></span></strong></p>

<p><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">To study benefit of reaching optimal medical therapy in real life heart failure cohort patients.</span></span></span></p>

<p><strong><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Methods</span></span></span></strong></p>

<p><span style="font-family:Calibri"><span style="font-size:medium"><span style="color:#000000">Consecutive patients with heart failure diagnosis, ejection fraction &lt;50% and regular follow-up for at least 12 months in a heart failure unit (n=262, mean follow-up of 485,3&nbsp; &plusmn; 184,6 days) were included. Patients with optimal medical therapy (OMT) were compared with patients without OMT.</span></span></span></p>

<p><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">OMT was defined as at least 50% of target doses of all of three principal prognostic modifying drugs in heart failure (mineralocorticoid antagonists; aldosterone conversion enzyme inhibitor/aldosterone receptor antagonist; beta-blocker). </span></span></span></p>

<p><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Primary end-point was defined as death and secondary endpoint was a combined hospitalization or an emergency unscheduled visit due to heart failure (MACE). </span></span></span></p>

<p><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Between patients that did not reach OMT were made a subgroup stratification with patients under at least 50% of target doses of only one drug class or only two drug classes and compared survival outcomes between them.</span></span></span></p>

<p><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">To estimate trends in survival curves of each group was used Kaplan-Meier test and Chi Square test to compare secondary endpoint between groups.</span></span></span></p>

<p><span style="font-family:Calibri"><span style="font-size:medium"><span style="color:#000000">&nbsp;Groups basal characteristics and comorbidities were adjusted (see table 1).&nbsp;&nbsp;&nbsp; </span></span></span></p>

<p><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Significance was considered when P&lt; 0,05.</span></span></span></p>

<p><strong><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Results </span></span></span></strong></p>

<p><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Patients that reached OMT had a better vital prognoses compared to patients that did not reach it during follow-up period (mortality 1,6% vs 9,5%, p= 0,006). Mean follow-up time was similar in two groups (498 vs 478 days, P= 0,43). Also, secondary endpoint (MACE) occurred significantly fewer times in subgroup of patients that reach OMT (23,08% vs 76% of pts, P= 0,001). Kaplan-Meier survival curve can be seen in figure 1.</span></span></span></p>

<p><span style="font-family:Calibri"><span style="font-size:medium"><span style="color:#000000">After subgroup stratification patients that reached at least 50% of target doses in only one or two of class drugs had significantly better prognoses compared to patients without 50% of target dose in any drug class and similar between them. (3,5%vs 2,2% vs 18,8% respectively, P&lt;0,001).&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></span></span></p>

<p><span style="font-family:Calibri"><span style="font-size:medium"><span style="color:#000000"><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Patients that reach OMT were significantly younger and with better renal function. Other basal characteristics were similar.</span></span></span></span></span></span></p>

<p><span style="font-family:Calibri"><span style="font-size:medium"><span style="color:#000000"><strong>Discussion</strong></span></span></span></p>

<p><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Our results suggests that reaching OMT of at least one heart failure class can have a significant impact in heart failure prognosis. As expected patients on OMT of all drugs classes had less MACEs and longer survival. Basal renal function and age, but not&nbsp; kalemia, were main predictive factors to reach OMT. </span></span></span></p>