Impact of drug therapy on long-term prognosis in patients with ischemic chronic heart failure with reduced ejection fraction and renal dysfunction
DOI:
https://doi.org/10.14739/2310-1210.2016.4.79758Keywords:
heart failure, drug therapy, kidneyAbstract
Despite the achievements of recent decades, chronic heart failure (CHF) is one of the most widespread and steadily progressive disease which accompanied by high mortality.
Aim. To investigate the effect of combined drug therapy for long-term prognosis in patients with ischemic heart failure with reduced ejection fraction of left ventricle and renal dysfunction.
Materials and methods. The study involved 140 patients (114 (81.4%) men) with ischemic chronic heart failure; average age was 60 [54.5-68] years. Therapy included: ACE inhibitors/ARBs (90%), beta blockers (94.3%), diuretics (87.8%), statins (84.3%), mineralocorticoid receptor antagonists (75%), antiplatelet agents (70.7%), calcium antagonists (14.3%), amiodarone (18.6%), ivabradin (15%). The cumulative survival curves were constructed by the Kaplan-Meier method using and groups were compared with the log-rank test.
Results. In our study it has been established that statins inclusion in the therapy of patients with ischemic heart failure with reduced ejection fraction of left ventricle and renal dysfunction reduces the risk of cumulative endpoint by 51% (hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.26 -0.91, p=0.02), prescription of trimetazidine - by 43% (HR 0.57, 95% CI 0.34-0.95, p=0.03), nitrates - by 47% (HR 0.53; 95% CI 0.31-0.89, p=0.01). Inclusion of mineralocorticoid receptor antagonists increased number of cardiovascular events during three years of monitoring (HR 1.88, 95% CI 1.21-2.94, p=0.005). Inclusion of aspirin reduced the risk of SCD by 75% (HR 0.25, 95% CI 0.12-0.53, p=0.0004). Inclusion of nitrates by 55% (HR 0.45, 95% CI 0.23-0.89, p=0.02) and statins by 68% (HR 0.32, 95% CI 0.14-0.72; p=0.006) reduced hospitalization.
Conclusion. Based on three-year monitoring results of ischemic heart failure patients with reduced ejection fraction and renal dysfunction it has been found that the inclusion of statins, nitrates, trimetazidine to standard therapy was associated with reduced risk of cumulative endpoint and hospitalization caused by heart failure decompensation.
References
Ponikowski, P., Voors, A., Anker, S., Bueno, H., Cleland, J., Coats, A. et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 37(27), 2129–2200.
Damman, K. & Testani, J. (2015). The kidney in heart failure: an update. European Heart Journal, 36(23), 1437–1444.
Voronkov, L. H., Amosova, K. M., Bahrii, A. E., Dziak, H. V., Diadyk, O. I., Zharinov, O. Y., et al. (2012). Rekomendatsii z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti [Guidelines for the diagnosis and treatment of chronic heart failure]. Sertseva nedostatnist, 3, 60–96 [in Ukrainian].
Wang, J., Wu, G., Wang, Z., Dai, X., & Li, X. (2014). Long-term Clinical Outcomes of Statin Use for Chronic Heart Failure: A Meta-analysis of 15 Prospective Studies. Heart, Lung And Circulation, 23(2), 105–113. doi: 10.1016/j.hlc.2013.07.012.
Chrusciel, P., Rysz, J., & Banach, M. (2014). Defining the Role of Trimetazidine in the Treatment of Cardiovascular Disorders: Some Insights on Its Role in Heart Failure and Peripheral Artery Disease. Drugs, 74(9), 971–980. doi: 10.1007/s40265-014-0233-5.
Fragasso, G., Palloshi, A., Puccetti, P., Silipigni, C., Rossodivita, A., Pala, M. et al. (2006). A Randomized Clinical Trial of Trimetazidine, a Partial Free Fatty Acid Oxidation Inhibitor, in Patients With Heart Failure. Journal Of The American College Of Cardiology, 48(5), 992–998. doi: 10.1016/j.jacc.2006.03.060
Fragasso, G., Rosano, G., Baek, S., Sisakian, H., Di Napoli, P., Alberti, L. et al. (2013). Effect of partial fatty acid oxidation inhibition with trimetazidine on mortality and morbidity in heart failure: Results from an international multicentre retrospective cohort study. International Journal Of Cardiology, 163(3), 320–325. doi: 10.1016/j.ijcard.2012.09.123.
Zannad, F., Gattis Stough, W., Rossignol, P., Bauersachs, J., McMurray, J., Swedberg, K. et al. (2012). Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction: integrating evidence into clinical practice. European Heart Journal, 33(22), 2782–2795. doi: 10.1093/eurheartj/ehs257.
Juurlink, D., Mamdani, M., Lee, D., Kopp, A., Austin, P., Laupacis, A., & Redelmeier, D. (2004). Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study (RALES). New England Journal Of Medicine, 351(6), 543–551. doi: http://dx.doi.org/10.1056/nejmoa040135.
Bowling, C., Pitt, B., Ahmed, M., Aban, I., Sanders, P., Mujib, M., et al. (2010). Hypokalemia and Outcomes in Patients With Chronic Heart Failure and Chronic Kidney Disease: Findings From Propensity-Matched Studies. Circulation: Heart Failure, 3(2), 253–260. doi: 10.1161/CIRCHEARTFAILURE.109.899526.
Goyal, A., Spertus, J., Gosch, K., Venkitachalam, L., Jones, P., Van den Berghe, G., & Kosiborod, M. (2012). Serum Potassium Levels and Mortality in Acute Myocardial Infarction. JAMA, 307(2), 157. doi: 10.1001/jama.2011.1967.
Hawwa, N., Schreiber, M., & Tang, W. (2013). Pharmacologic Management of Chronic Reno-Cardiac Syndrome. Curr Heart Fail Rep, 10(1), 54–62. doi: 10.1007/s11897-012-0122-8.
Tokmakova, M., Skali, H., Kenchaiah, S., Braunwald, E., Rouleau, J. L., Packer, M., et al. (2004). Chronic Kidney Disease, Cardiovascular Risk, and Response to Angiotensin-Converting Enzyme Inhibition After Myocardial Infarction: The Survival And Ventricular Enlargement (SAVE) Study. Circulation, 110(24), 3667–3673. doi: http://dx.doi.org/10.1161/01.CIR.0000149806.01354.BF.
Konstam, M., Neaton, J., Dickstein, K., Drexler, H., Komajda, M., Martinez, F. et al. (2009). Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial. The Lancet, 374(9704), 1840–1848. doi: 10.1016/S0140-6736(09)61913-9.
Dickstein, K. & Kjekshus, J. (2002). Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. The Lancet, 360(9335), 752–760. doi: http://dx.doi.org/10.1016/S0140-6736(02)09895-1.
Castagno, D., Jhund, P., McMurray, J., Lewsey, J., Erdmann, E., Zannad, F. et al. (2010). Improved survival with bisoprolol in patients with heart failure and renal impairment: an analysis of the cardiac insufficiency bisoprolol study II (CIBIS-II) trial. European Journal Of Heart Failure, 12(6), 607–616. doi: 10.1093/eurjhf/hfq038.
Swedberg, K., Komajda, M., Böhm, M., Borer, J., Ford, I., Dubost-Brama, A. et al. (2010). Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. The Lancet, 376(9744), 875–885. doi: 10.1016/S0140-6736(10)61198-1.
Fox, K., Ford, I., Steg, P., Tendera, M., & Ferrari, R. (2008). Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. The Lancet, 372(9641), 807–816. doi: 10.1016/S0140-6736(08)61170-8.
Damman, K., Ng Kam Chuen, M., MacFadyen, R., Lip, G., Gaze, D., Collinson, P. et al. (2011). Volume Status and Diuretic Therapy in Systolic Heart Failure and the Detection of Early Abnormalities in Renal and Tubular Function. Journal Of The American College Of Cardiology, 57(22), 2233–2241. doi: 10.1016/j.jacc.2010.10.065.
Bikdeli, B., Strait, K., Dharmarajan, K., Partovian, C., Coca, S., Kim, N. et al. (2013). Dominance of Furosemide for Loop Diuretic Therapy in Heart Failure. Journal Of The American College Of Cardiology, 61(14), 1549–1550. doi: 10.1016/j.jacc.2012.12.043.
Cohn, J. (1988). Effect of vasodilator therapy on mortality in chronic congestive heart failure. European Heart Journal, 9(suppl A), 171–173. http://dx.doi.org/10.1093/eurheartj/9.suppl_a.171
Carson, P., Ziesche, S., Johnson, G., & Cohn, J. (1999). Racial differences in response to therapy for heart failure: Analysis of the vasodilator-heart failure trials. Journal Of Cardiac Failure, 5(3), 178–187.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
