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Association of Guideline-Based Medical Therapy with Malignant Arrhythmias and Mortality among Heart Failure Patients

Tal Hasin1,2, Ilia Davarashvili1, Yoav Michowitz1,2

  • 1Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel.

Journal of Clinical Medicine
|April 30, 2021
PubMed

Insights

Higher doses of beta-blockers (BB) reduced ventricular arrhythmia (VA) in heart failure (HF) patients with defibrillator devices. Angiotensin-antagonists (AngA) were linked to improved survival, though medication doses were often low.

Area of Science:

  • Cardiology
  • Pharmacology
  • Medical Devices

Background:

  • Heart failure (HF) management involves medications and implantable devices like defibrillators (ICD/CRTD).
  • Understanding medication impact on outcomes like ventricular arrhythmia (VA) and survival is crucial for HF patients with primary prevention ICD/CRTD.

Purpose of the Study:

  • To evaluate the prevalence of HF medications in patients receiving ICD/CRTD devices.
  • To determine the association between these medications and the incidence of VA and overall survival.

Main Methods:

  • Retrospective analysis of 186 HF patients post-ICD/CRTD implantation.
  • Examined treatment and dosage of beta-adrenergic receptor antagonists (BB), angiotensin-antagonists (AngA), and mineralocorticoid-antagonists (MRA).
  • Assessed associations with VA and mortality using multivariable models.

Main Results:

  • High medication prevalence: BB (83%), AngA (87%), MRA (59%), but median doses were low (25% of target).
  • Increased BB dose (>25% target) was associated with reduced VA incidence (HR 0.443, p=0.021).
  • Angiotensin-antagonist treatment was associated with reduced mortality (HR 0.515, p=0.028), while VA increased mortality (HR 2.672, p=0.002).

Conclusions:

  • Guideline-based HF medication use was high in this real-world cohort, but doses were suboptimal.
  • Higher BB doses correlate with decreased VA, and AngA treatment with improved survival in ICD/CRTD patients.
  • Further research into optimizing medication dosing in HF patients with defibrillators is warranted.
Abstract

Keywords:
arrhythmiadefibrillatorheart failuremedical treatment

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