The effect of kidney function on guideline-directed medical therapy implementation and prognosis in heart failure...

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Kidney dysfunction (KD) significantly hinders guideline-directed medical therapy (GDMT) application and target dose achievement in heart failure with reduced ejection fraction (HFrEF).
• Optimizing neurohormonal antagonist triple therapy (TT) in HFrEF patients post-hospitalization requires careful consideration of kidney function.

Purpose of the Study:

• To evaluate the success, long-term applicability, and adherence of neurohormonal antagonist triple therapy (TT) in HFrEF patients after hospitalization, stratified by kidney dysfunction (KD) severity.
• To investigate the prognostic impact of TT application and adherence on mortality and rehospitalization rates in HFrEF patients with varying degrees of KD.

Main Methods:

• Analysis of 247 real-world HFrEF patients hospitalized between 2019-2021, followed for 1 year.
• Assessment of TT (RASi, βB, MRA) application and target dose achievement at discharge and 1-year follow-up across different KD categories (eGFR levels).
• Investigation of 1-year all-cause mortality and rehospitalization rates (all-cause and HF-specific) in relation to KD severity.

Main Results:

• A majority of patients received TT at discharge (77%) and 1 year (73%), with lower application rates in more severe KD.
• Patients with more severe KD were less likely to achieve target doses of MRA and RASi.
• Higher KD severity correlated with significantly increased 1-year all-cause mortality, all-cause rehospitalizations, and HF-specific rehospitalizations.

Conclusions:

• Kidney dysfunction poses a significant barrier to the optimal application and titration of triple therapy in HFrEF.
• Despite challenges, the study underscores the critical importance of actively implementing and up-titrating GDMT, even in patients with KD, to improve survival and reduce hospital readmissions.