Description
- Abstract:
- Heart failure (HF) represents a significant and growing public health problem. Potentially beneficial HF therapies are often underused among patients hospitalized for HF and may contribute to higher rates of mortality and rehospitalization post-discharge. The purpose of this dissertation, therefore, was to identify optimal pharmacotherapies for the management of HF with left ventricular systolic dysfunction (LVSD) at hospital discharge. Participants included veterans sampled for Veterans Affairs (VA) External Peer Review Program HF performance measures and hospitalized for HF with LVSD at a VA medical center between 2003 and 2007. First, we examined the relationship between discharge therapy with an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), β-adrenergic blocker (BB), and the combination thereof, and clinical outcomes. Using 1:1:1 propensity score matching, we found receipt of a BB at discharge without adjunctive ACEI/ARB therapy was associated with an increased risk of mortality within 30 days compared with individual ACEI/ARB therapy and combined therapy. Second, we examined ACEI /ARB therapy at discharge among patients with comorbid renal dysfunction. Patients with HF with LVSD and renal dysfunction who received an ACEI/ARB at discharge had a lower risk of HF rehospitalization over one year compared with propensity-matched patients who did not receive an ACEI/ARB. Third, although non-dihydropyridine (DHP) calcium channel blockers (CCBs) are used to treat atrial arrhythmias, their safety in patients with HF with LVSD is uncertain. We therefore investigated the relationship between non-DHP CCB receipt at discharge and clinical outcomes among patients with supraventricular tachyarrhythmias hospitalized for HF with LVSD. We observed a reduction in all-cause mortality within 6 months among patients who received a non-DHP CCB at discharge, the majority of whom received concomitant ACEI/ARB therapy. Our findings suggest certain HF therapies may be safe and beneficial when used in decompensated HF patients with LVSD and those with potential contraindications to therapy. In each study, receipt of a renin-angiotensin system inhibitor at discharge appeared to be optimal among patients with HF with LVSD, even among patients with renal dysfunction.
- Notes:
- Thesis (Ph.D. -- Brown University (2012)
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Citation
Grebla, Regina Catherine,
"Optimal Pharmacotherapy for the Management of Heart Failure with Left Ventricular Systolic Dysfunction at Hospital Discharge"
(2012).
Epidemiology Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://doi.org/10.7301/Z0NC5ZGH
