Prognostic significance of medical therapy in patients with heart failure with reduced ejection fraction

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dc.authorscopusid57211015002
dc.authorscopusid25951372300
dc.authorscopusid36997320400
dc.authorscopusid57207828905
dc.authorscopusid56798403300
dc.authorscopusid57202391627
dc.authorscopusid57207822506
dc.contributor.authorKocabaş, U.
dc.contributor.authorErgin, I.
dc.contributor.authorKıvrak, T.
dc.contributor.authorYılmaz, Öztekin, G.M.
dc.contributor.authorTanık, V.O.
dc.contributor.authorÖzdemir, İ.
dc.contributor.authorAvcı, Demir, F.
dc.date.accessioned2024-08-25T18:48:13Z
dc.date.available2024-08-25T18:48:13Z
dc.date.issued2023
dc.departmentEge Üniversitesien_US
dc.description.abstractAims: The use of guideline-directed medical therapy (GDMT) among patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains suboptimal. The SMYRNA study aims to identify the clinical factors for the non-use of GDMT and to determine the prognostic significance of GDMT in patients with HFrEF in a real-life setting. Methods and results: The SMYRNA study is a prospective, multicentre, and observational study that included outpatients with HFrEF. Patients were divided into three groups according to the status of GDMT at the time of enrolment: (i) patients receiving all classes of HF medications including renin-angiotensin system (RAS) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRAs); (ii) patients receiving any two classes of HF medications (RAS inhibitors and beta-blockers, or RAS inhibitors and MRAs, or beta-blockers and MRAs); and (iii) either patients receiving class of HF medications (only one therapy) or patients not receiving any class of HF medications. The primary outcome was a composite of hospitalization for HF or cardiovascular death. The study population consisted of 1062 patients with HFrEF, predominantly men (69.1%), with a median age of 68 (range: 20–96) years. RAS inhibitors, beta-blockers, and MRAs were prescribed in 76.0%, 89.4%, and 55.1% of the patients, respectively. The proportions of patients receiving target doses of guideline-directed medications were 24.4% for RAS inhibitors, 11.0% for beta-blockers, and 11.1% for MRAs. Overall, 491 patients (46.2%) were treated with triple therapy, 353 patients (33.2%) were treated with any two classes of HF medications, and 218 patients (20.6%) were receiving only one class of HF medication or not receiving any HF medication. Patient-related factors comprising older age, New York Heart Association functional class, rural living, presence of hypertension, and history of myocardial infarction were independently associated with the use or non-use of GDMT. During the median 24-month period, the primary composite endpoint occurred in 362 patients (34.1%), and 177 of 1062 (16.7%) patients died. Patients treated with two or three classes of HF medications had a decreased risk of hospitalization for HF or cardiovascular death compared with those patients receiving ?1 class of HF medication [hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.49–0.85; P = 0.002, and HR: 0.61; 95% CI: 0.47–0.79; P < 0.001, respectively]. Conclusions: The real-life SMYRNA study provided comprehensive data about the clinical factors associated with the non-use of GDMT and showed that suboptimal GDMT is associated with an increased risk of hospitalization for HF or cardiovascular death in patients with HFrEF. © 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.en_US
dc.identifier.doi10.1002/ehf2.14559
dc.identifier.issn2055-5822
dc.identifier.pmid37804042en_US
dc.identifier.scopus2-s2.0-85173454559en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.urihttps://doi.org/10.1002/ehf2.14559
dc.identifier.urihttps://hdl.handle.net/11454/102195
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherJohn Wiley and Sons Incen_US
dc.relation.ispartofESC Heart Failureen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.snmz20240825_Gen_US
dc.subjectGuideline-directed medical therapyen_US
dc.subjectHeart failureen_US
dc.subjectHospitalizationen_US
dc.subjectMortalityen_US
dc.titlePrognostic significance of medical therapy in patients with heart failure with reduced ejection fractionen_US
dc.typeArticleen_US

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