TY - JOUR
T1 - Association between evidence-based medication at discharge and outcomes in patients with heart failure
T2 - a systematic review and meta-analysis
AU - Feng, Jia Li
AU - Qin, Xiwen
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
KW - Evidence-based medications
KW - Heart failure
KW - Meta-analysis
KW - Readmission
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85076600704&partnerID=8YFLogxK
U2 - 10.1007/s10741-019-09900-3
DO - 10.1007/s10741-019-09900-3
M3 - Review article
C2 - 31848792
AN - SCOPUS:85076600704
SN - 1382-4147
VL - 26
SP - 81
EP - 89
JO - Heart Failure Reviews
JF - Heart Failure Reviews
IS - 1
ER -