Skip to main content

Advertisement

SpringerLink
Log in

Association between evidence-based medication at discharge and outcomes in patients with heart failure: a systematic review and meta-analysis

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

To conduct a meta-analysis of observational studies assessing the association between dispensing evidence-based medications (EBMs) at discharge and outcomes, we extracted published studies in English from PubMed, Medline, and EMBASE from 2007 to early 2019. The EBMs included renin-angiotensin system inhibitors (RASIs), β-blockers, and mineralocorticoid receptor antagonists (MRAs). The main outcomes of interest were all-cause death and heart failure (HF) readmission. Pooled hazard ratios (HRs) were calculated using random effect model from the adjusted HRs or relative risks (RRs) extracted from individual studies, stratified by HF patients with reduced ejection fraction (HFrEF), and preserved ejection fraction (HFpEF). Forty-three studies including a total number of 295,060 patients with an average follow-up time of 2.3 years were identified for systematic review. Dispensing RASI at discharge was independently associated with 30% and 25% lower risks of all-cause death and HF readmission respectively in HFrEF but has a moderate effect on reducing all-cause deaths (HR = 0.88, 95% CI: 0.81–0.95) in HFpEF. By contrast, dispensing β-blockers at discharge was associated with 35% lower risk of all-cause deaths in HFrEF and has a weak association with borderline statistical significance on improving overall survival in HFpEF. Dispensing MRA at discharge was associated with 5% lower risk of all-cause death in HFrEF. This meta-analysis provides evidence to support RASIs and β-blockers as primary pharmacotherapies for HF patients. Our findings suggest that the health professionals maintain use of RASIs and β-blockers at discharge for potential survival improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the heart failure association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://doi.org/10.1093/eurheartj/ehw128

    Article  PubMed  Google Scholar 

  2. Fonarow GC, Abraham WT, Albert NM, Gattis WA, Gheorghiade M, Greenberg B, O'Connor CM, Yancy CW, Young J (2004) Organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF): rationale and design. Am Heart J 148(1):43–51. https://doi.org/10.1016/j.ahj.2004.03.004

    Article  PubMed  Google Scholar 

  3. Yancy Clyde W, Jessup M, Bozkurt B, Butler J, Casey Donald E, Colvin Monica M, Drazner Mark H, Filippatos Gerasimos S, Fonarow Gregg C, Givertz Michael M, Hollenberg Steven M, Lindenfeld J, Masoudi Frederick A, McBride Patrick E, Peterson Pamela N, Stevenson Lynne W, Westlake C (2017) 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America. Circulation 136(6):e137–e161. https://doi.org/10.1161/CIR.0000000000000509

    Article  PubMed  CAS  Google Scholar 

  4. Bavishi C, Chatterjee S, Ather S, Patel D, Messerli FH (2015) Beta-blockers in heart failure with preserved ejection fraction: a meta-analysis. Heart Fail Rev 20(2):193–201. https://doi.org/10.1007/s10741-014-9453-8

    Article  PubMed  CAS  Google Scholar 

  5. Flather MD, Yusuf S, Kober L, Pfeffer M, Hall A, Murray G, Torp-Pedersen C, Ball S, Pogue J, Moye L, Braunwald E (2000) Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-inhibitor myocardial infarction collaborative group. Lancet 355(9215):1575–1581

    Article  CAS  Google Scholar 

  6. Al-Mallah MH, Tleyjeh IM, Abdel-Latif AA, Weaver WD (2006) Angiotensin-converting enzyme inhibitors in coronary artery disease and preserved left ventricular systolic function: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Cardiol 47(8):1576–1583. https://doi.org/10.1016/j.jacc.2005.11.073

    Article  PubMed  CAS  Google Scholar 

  7. Shibata MC, Flather MD, Wang D (2001) Systematic review of the impact of beta blockers on mortality and hospital admissions in heart failure. Eur J Heart Fail 3(3):351–357

    Article  CAS  Google Scholar 

  8. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hayden JA, Cote P, Bombardier C (2006) Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 144(6):427–437

    Article  Google Scholar 

  10. DerSimonian R, Kacker R (2007) Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials 28(2):105–114

    Article  Google Scholar 

  11. Sterne JAC, Gavaghan D, Egger M (2000) Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol 53(11):1119–1129. https://doi.org/10.1016/S0895-4356(00)00242-0

    Article  PubMed  CAS  Google Scholar 

  12. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A (2008) Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med 359(23):2456–2467. https://doi.org/10.1056/NEJMoa0805450

    Article  PubMed  CAS  Google Scholar 

  13. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J (2003) Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-preserved trial. Lancet 362(9386):777–781. https://doi.org/10.1016/s0140-6736(03)14285-7

    Article  PubMed  CAS  Google Scholar 

  14. Cleland JG, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J (2006) The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 27(19):2338–2345. https://doi.org/10.1093/eurheartj/ehl250

    Article  PubMed  CAS  Google Scholar 

  15. Lund Lars H, Svennblad B, Melhus H, Hallberg P, Dahlström U, Edner M (2013) Association of spironolactone use with all-cause mortality in heart failure. Circ Heart Fail 6(2):174–183. https://doi.org/10.1161/CIRCHEARTFAILURE.112.000115

    Article  PubMed  CAS  Google Scholar 

  16. Shah R, Wang Y, Foody JM (2008) Effect of statins, angiotensin-converting enzyme inhibitors, and beta blockers on survival in patients >or=65 years of age with heart failure and preserved left ventricular systolic function. Am J Cardiol 101(2):217–222. https://doi.org/10.1016/j.amjcard.2007.08.050

    Article  PubMed  CAS  Google Scholar 

  17. Hernandez AF, Hammill BG, O'Connor CM, Schulman KA, Curtis LH, Fonarow GC (2009) Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (organized program to initiate lifesaving treatment in hospitalized patients with heart failure) registry. J Am Coll Cardiol 53(2):184–192. https://doi.org/10.1016/j.jacc.2008.09.031

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Lam PH, Gupta N, Dooley DJ, Singh S, Deedwania P, Zile MR, Bhatt DL, Morgan CJ, Pitt B, Fonarow GC, Ahmed A (2018) Role of high-dose Beta-blockers in patients with heart failure with preserved ejection fraction and elevated heart rate. Am J Med 131(12):1473–1481. https://doi.org/10.1016/j.amjmed.2018.07.008

    Article  PubMed  CAS  Google Scholar 

  19. Bhatia V, Bajaj NS, Sanam K, Hashim T, Morgan CJ, Prabhu SD, Fonarow GC, Deedwania P, Butler J, Carson P, Love TE, Kheirbek R, Aronow WS, Anker SD, Waagstein F, Fletcher R, Allman RM, Ahmed A (2015) Beta-blocker use and 30-day all-cause readmission in Medicare beneficiaries with systolic heart failure. Am J Med 128(7):715–721. https://doi.org/10.1016/j.amjmed.2014.11.036

    Article  PubMed  Google Scholar 

  20. Qin X, Hung J, Knuiman M, Teng TK, Briffa T, Sanfilippo FM (2018) Evidence-based pharmacotherapies used in the postdischarge phase are associated with improved one-year survival in senior patients hospitalized with heart failure. Cardiovasc Ther 36(6):e12464. https://doi.org/10.1111/1755-5922.12464

    Article  PubMed  CAS  Google Scholar 

  21. Platz E, Jhund PS, Claggett BL, Pfeffer MA, Swedberg K, Granger CB, Yusuf S, Solomon SD, McMurray JJ (2018) Prevalence and prognostic importance of precipitating factors leading to heart failure hospitalization: recurrent hospitalizations and mortality. Eur J Heart Fail 20(2):295–303. https://doi.org/10.1002/ejhf.901

    Article  PubMed  Google Scholar 

  22. Arrigo M, Gayat E, Parenica J, Ishihara S, Zhang J, Choi DJ, Park JJ, Alhabib KF, Sato N, Miro O, Maggioni AP, Zhang Y, Spinar J, Cohen-Solal A, Iwashyna TJ, Mebazaa A (2017) Precipitating factors and 90-day outcome of acute heart failure: a report from the intercontinental GREAT registry. Eur J Heart Fail 19(2):201–208. https://doi.org/10.1002/ejhf.682

    Article  PubMed  Google Scholar 

  23. Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, O'Connor CM, Pieper K, Sun JL, Yancy CW, Young JB (2008) Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med 168(8):847–854. https://doi.org/10.1001/archinte.168.8.847

    Article  PubMed  Google Scholar 

  24. Vindhyal MR, Khayyat S, Shaaban A, Duran BA, Kallail KJ (2018) Decreased renal function is associated with heart failure readmissions. Cureus 10(8):e3122–e3122. https://doi.org/10.7759/cureus.3122

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cowie MR, Anker SD, Cleland JGF, Felker GM, Filippatos G, Jaarsma T, Jourdain P, Knight E, Massie B, Ponikowski P, López-Sendón J (2014) Improving care for patients with acute heart failure: before, during and after hospitalization. ESC Heart Failure 1(2):110–145. https://doi.org/10.1002/ehf2.12021

    Article  PubMed  Google Scholar 

  26. Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, O'Connor CM, Sun JL, Yancy CW, Young JB (2007) Prospective evaluation of beta-blocker use at the time of hospital discharge as a heart failure performance measure: results from OPTIMIZE-HF. J Card Fail 13(9):722–731. https://doi.org/10.1016/j.cardfail.2007.06.727

    Article  PubMed  CAS  Google Scholar 

  27. Ahmed A, Fonarow GC, Zhang Y, Sanders PW, Allman RM, Arnett DK, Feller MA, Love TE, Aban IB, Levesque R, Ekundayo OJ, Dell'Italia LJ, Bakris GL, Rich MW (2012) Renin-angiotensin inhibition in systolic heart failure and chronic kidney disease. Am J Med 125(4):399–410. https://doi.org/10.1016/j.amjmed.2011.10.013

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Al-Meslmani BM, Fahoum SK, Shamia MG (2007) NT-proBNP in monitoring treatment of patients with congestive heart failure. Clin Lab 53(1–2):35–39

    PubMed  CAS  Google Scholar 

  29. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 341(10):709–717. https://doi.org/10.1056/NEJM199909023411001

    Article  PubMed  CAS  Google Scholar 

  30. Zannad F, McMurray JJV, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, Vincent J, Pocock SJ, Pitt B (2010) Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 364(1):11–21. https://doi.org/10.1056/NEJMoa1009492

    Article  PubMed  Google Scholar 

  31. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, Clausell N, Desai AS, Diaz R, Fleg JL, Gordeev I, Harty B, Heitner JF, Kenwood CT, Lewis EF, O'Meara E, Probstfield JL, Shaburishvili T, Shah SJ, Solomon SD, Sweitzer NK, Yang S, McKinlay SM (2014) Spironolactone for heart failure with preserved ejection fraction. N Engl J Med 370(15):1383–1392. https://doi.org/10.1056/NEJMoa1313731

    Article  PubMed  CAS  Google Scholar 

  32. Greenland S (2004) Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies. Am J Epidemiol 160(4):301–305. https://doi.org/10.1093/aje/kwh221

    Article  PubMed  Google Scholar 

  33. Solomon SD, Claggett B, Lewis EF, Desai A, Anand I, Sweitzer NK, O'Meara E, Shah SJ, McKinlay S, Fleg JL, Sopko G, Pitt B, Pfeffer MA (2016) Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J 37(5):455–462. https://doi.org/10.1093/eurheartj/ehv464

    Article  PubMed  CAS  Google Scholar 

  34. Lam CS, Solomon SD (2017) Fussing over the middle child: heart failure with mid-range ejection fraction. Circulation 135(14):1279–1280. https://doi.org/10.1161/circulationaha.117.027324

    Article  PubMed  Google Scholar 

  35. Koh AS, Tay WT, Teng THK, Vedin O, Benson L, Dahlstrom U, Savarese G, Lam CSP, Lund LH (2017) A comprehensive population-based characterization of heart failure with mid-range ejection fraction. Eur J Heart Fail 19(12):1624–1634. https://doi.org/10.1002/ejhf.945

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia

    Jia-Li Feng & Xiwen Qin

  2. Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

    Jia-Li Feng

Authors
  1. Jia-Li Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiwen Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jia-Li Feng.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 52.4 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feng, JL., Qin, X. Association between evidence-based medication at discharge and outcomes in patients with heart failure: a systematic review and meta-analysis. Heart Fail Rev 26, 81–89 (2021). https://doi.org/10.1007/s10741-019-09900-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-019-09900-3

Keywords

Search

Navigation