背景:肾功能障碍(KD)是在射血分数(HFrEF)降低的心力衰竭(HF)中应用指导药物治疗(GDMT)并达到推荐目标剂量(TD)的主要限制因素。
目标:我们旨在评估优化的成功程度,长期适用性,和神经激素拮抗剂三联疗法(TT:RASi[ACEi/ARB/ARNI]+βB+MRA)在HF住院后根据KD的依从性,并探讨其对预后的影响。
方法:247个真实世界的数据,对2019-2021年因HFrEF住院的连续患者进行分析,然后随访1年.比较KD类别(eGFR:≥90、60-89、45-59、30-44,<30mL/min/1.73m2),评估出院时和1年TT的应用和达到TD的比率。此外,调查KD亚组1年全因死亡率和再住院率。
结果:大多数患者在出院时(77%)和1年时(73%)接受了TT。更严重的KD导致TT(92%,88%,80%,73%,31%)出院时和1年时(81%,76%,76%,68%,40%)。患有更严重KD的患者不太可能(p<.05)接受MRA的TD(81%,68%,78%,61%,52%)在放电时和RASi(53%,49%,45%,21%,27%)在1年。一年全因死亡率(14%,15%,16%,33%,48%,p<.001),全因再住院的比率(30%,35%,40%,43%,52%,p=.028),和心力衰竭的再住院(8%,13%,18%,20%,38%,p=.001)在更严重的KD类别中显著更高。
结论:KD不利于TT在HFrEF中的应用,然而,其中较低的死亡率和再住院率突出了GDMT的有意识实施和上调的作用.
BACKGROUND: Kidney dysfunction (KD) is a main limiting factor of applying
guideline-directed medical therapy (GDMT) and reaching the recommended target doses (TD) in heart failure (HF) with reduced ejection fraction (HFrEF).
OBJECTIVE: We aimed to assess the success of optimization, long-term applicability, and adherence of neurohormonal antagonist triple therapy (TT:RASi [ACEi/ARB/ARNI] + βB + MRA) according to the KD after a HF hospitalization and to investigate its impact on prognosis.
METHODS: The data of 247 real-world, consecutive patients were analyzed who were hospitalized in 2019-2021 for HFrEF and then were followed-up for 1 year. The application and the ratio of reached TD of TT at hospital discharge and at 1 year were assessed comparing KD categories (eGFR: ≥90, 60-89, 45-59, 30-44, <30 mL/min/1.73 m2 ). Moreover, 1-year all-cause mortality and rehospitalization rates in KD subgroups were investigated.
RESULTS: Majority of the patients received TT at hospital discharge (77%) and at 1 year (73%). More severe KD led to a lower application ratio (p < .05) of TT (92%, 88%, 80%, 73%, 31%) at discharge and at 1 year (81%, 76%, 76%, 68%, 40%). Patients with more severe KD were less likely (p < .05) to receive TD of MRA (81%, 68%, 78%, 61%, 52%) at discharge and a RASi (53%, 49%, 45%, 21%, 27%) at 1 year. One-year all-cause mortality (14%, 15%, 16%, 33%, 48%, p < .001), the ratio of all-cause rehospitalizations (30%, 35%, 40%, 43%, 52%, p = .028), and rehospitalizations for HF (8%, 13%, 18%, 20%, 38%, p = .001) were significantly higher in more severe KD categories.
CONCLUSIONS: KD unfavorably affects the application of TT in HFrEF, however poorer mortality and rehospitalization rates among them highlight the role of the conscious implementation and up-titration of GDMT.