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Abstract：
Treatment of heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medication therapy (GDMT) consisting of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in combination with an indicated beta-blocker. There is concern that end-stage renal disease (ESRD) patients are not being prescribed GDMT. The study aim was to determine whether outcomes differ for patients with HFrEF and ESRD receiving GDMT compared to those not receiving GDMT.
Adult patients with ESRD and HFrEF admitted to a tertiary teaching hospital over a 2-year period were included. Patients were categorized into GDMT or non-GDMT groups based on their home medications. The length of stay (LOS), mortality, and 30-day hospital readmissions were compared between groups. The incidence of hyperkalemia, hypotension and bradycardia were also evaluated.
A total of 109 patients were included: 88% African-American, 61% males, median age 63 (28-93) years with 25 in the GDMT group and 84 in the non-GDMT group. The LOS did not differ between the GDMT (5 days; 3-14) compared to the non-GDMT group (7 days; 3-28), P = 0.14. Thirty-day hospital readmission and in-hospital mortality were also similar. Hypotension occurred less frequently in the GDMT group compared to the non-GDMT group, 4% versus 27% (P = 0.01).
Although there were no differences in the primary outcomes, the shorter LOS in the GDMT group may be clinically significant. The fact that most patients with ESRD and HFrEF were not receiving GDMT is a finding that requires further evaluation.
Adult patients with ESRD and HFrEF admitted to a tertiary teaching hospital over a 2-year period were included. Patients were categorized into GDMT or non-GDMT groups based on their home medications. The length of stay (LOS), mortality, and 30-day hospital readmissions were compared between groups. The incidence of hyperkalemia, hypotension and bradycardia were also evaluated.
A total of 109 patients were included: 88% African-American, 61% males, median age 63 (28-93) years with 25 in the GDMT group and 84 in the non-GDMT group. The LOS did not differ between the GDMT (5 days; 3-14) compared to the non-GDMT group (7 days; 3-28), P = 0.14. Thirty-day hospital readmission and in-hospital mortality were also similar. Hypotension occurred less frequently in the GDMT group compared to the non-GDMT group, 4% versus 27% (P = 0.01).
Although there were no differences in the primary outcomes, the shorter LOS in the GDMT group may be clinically significant. The fact that most patients with ESRD and HFrEF were not receiving GDMT is a finding that requires further evaluation.
摘要：
射血分数降低的心力衰竭（HFrEF）的治疗需要指南指导的药物治疗（GDMT），包括血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂以及指定的β受体阻滞剂。人们担心终末期肾病（ESRD）患者未接受GDMT处方。该研究旨在确定接受GDMT的HFrEF和ESRD患者与未接受GDMT的患者的预后是否不同。
纳入三级教学医院2年的ESRD和HFrEF成年患者。患者根据其家庭用药分为GDMT或非GDMT组。停留时间（LOS），死亡率,并比较两组间30天的再入院时间.高钾血症的发病率，还评估了低血压和心动过缓。
共纳入109名患者：88%的非裔美国人，61%的男性，中位年龄63(28-93)岁,GDMT组25岁,非GDMT组84岁.与非GDMT组（7天；3-28）相比，GDMT组（5天；3-14天）的LOS没有差异，P=0.14。30天住院再入院和住院死亡率也相似。与非GDMT组相比，GDMT组低血压发生率较低，4%对27%(P=0.01)。
虽然主要结果没有差异，GDMT组LOS较短可能具有临床意义.大多数ESRD和HFrEF患者未接受GDMT的事实需要进一步评估。
纳入三级教学医院2年的ESRD和HFrEF成年患者。患者根据其家庭用药分为GDMT或非GDMT组。停留时间（LOS），死亡率,并比较两组间30天的再入院时间.高钾血症的发病率，还评估了低血压和心动过缓。
共纳入109名患者：88%的非裔美国人，61%的男性，中位年龄63(28-93)岁,GDMT组25岁,非GDMT组84岁.与非GDMT组（7天；3-28）相比，GDMT组（5天；3-14天）的LOS没有差异，P=0.14。30天住院再入院和住院死亡率也相似。与非GDMT组相比，GDMT组低血压发生率较低，4%对27%(P=0.01)。
虽然主要结果没有差异，GDMT组LOS较短可能具有临床意义.大多数ESRD和HFrEF患者未接受GDMT的事实需要进一步评估。
