Impact of drug therapy on long-term prognosis in patients with ischemic chronic heart failure with preserved ejection fraction and renal dysfunction
DOI:
https://doi.org/10.14739/2310-1210.2016.5.82566Keywords:
Heart Failure, Drug Therapy, KidneyAbstract
Improvement of the treatment of cardiovascular disease has led to an increase number of patients with chronic heart failure with preserved ejection fraction (HFpEF), but at the moment there is no differentiated approach based on the principles of evidence-based medicine.
Aim. To investigate the effect of modern combined drug therapy for long-term prognosis in patients with ischemic HFpEF and renal dysfunction.
Materials and methods. The study involved 243 patients (80.3% men) with ischemic HFpEF with renal dysfunction (age 58.7±9.3 years). Therapy included: ACE inhibitors/ARBs (98.3 %), statins (95.9 %), antiplatelet agents (94.2 %), beta blockers (91.3 %), diuretics (53.5 %), trimetazidine (30.9 %), calcium antagonists (26.3 %), mineralocorticoid receptor antagonists (16.5 %), amiodarone (11.9 %). The follow-up period was 3 years. The cumulative survival curves were constructed by the Kaplan-Meier method using and groups were compared with the log-rank test.
Results. It was found that the torasemide inclusion in the therapy of patients with ischemic HFpEF and renal dysfunction in comparison with furosemide was accompanied by a reduction in adverse cardiovascular events (hazard ratio (HR) 4.92; 95% CI 1.47-16.4; p=0.009), ARB has a positive effect (HR 0.46; 95% CI 0.21-1.07; p=0.07), and the inclusion of amiodarone was accompanied by an increase number of adverse events (HR 3.27; 95% CI 1.38-7.74, p=0.006). Beta-blockers reduced the risk of sudden cardiac death (HR 0.09; 95% CI 0.01-0.58, p=0.01). It was found that amiodarone (HR 4.69; 95% CI 1.26-17.3; p=0.02) and AMR (HR 4.81; 95% CI 1.62-14.3; p=0.004) increased the risk of hospitalization.
Conclusion. As a result of a three-year follow-up of patients with ischemic HFpEF and renal dysfunction it was found that among diuretics torasemide has preference over furosemide in respect of the impact on cumulative endpoint. Beta-blockers were effective in preventing sudden cardiac death, and angiotensin II receptor blockers reduced the risk of atherothrombotic events.
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. http://dx.doi.org/10.1093/eurheartj/ehw128.
Zile, M., Gaasch, W., Anand, I., Haass, M., Little, W., Miller, A., et al. (2010). Mode of Death in Patients With Heart Failure and a Preserved Ejection Fraction: Results From the Irbesartan in Heart Failure With Preserved Ejection Fraction Study (I-Preserve) Trial. Circulation, 121(12), 1393–1405. doi: 10.1161/CIRCULATIONAHA.109.909614.
Ness, A., Sanders, R., Brook, P., Gock, H., & Prior, D. (2016). Heart Failure in Patients with a Normal Left Ventricular Ejection Fraction. Heart, Lung And Circulation, 25, S112.
Damman, K., Valente, M., Voors, A., O'Connor, C., van Veldhuisen, D., & Hillege, H. (2014). Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. European Heart Journal, 35(7), 455–469. doi: 10.1093/eurheartj/eht386.
Voronkov, L. G., 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].
(2016). 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 134(13), e282–e293. doi: 10.1161/CIR.0000000000000435.
Carson, P., Massie, B., McKelvie, R., McMurray, J., Komajda, M., Zile, M. et al. (2005). The Irbesartan in Heart Failure With Preserved Systolic Function (I-PRESERVE) Trial: Rationale and Design. Journal Of Cardiac Failure, 11(8), 576–585. doi: http://dx.doi.org/10.1016/j.cardfail.2005.06.432.
Mottram, P. M., Haluska, B., Leano, R., Cowley, D., Stowasser, M., & Marwick, T. H. (2004). Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure. Circulation, 110(5), 558–565. http://dx.doi.org/10.1161/01.CIR.0000138680.89536.A9.
Cheitlin, M. (2009). Influence of Beta-Blocker Continuation or Withdrawal on Outcomes in Patients Hospitalized With Heart Failure: Findings From the OPTIMIZE-HF Program. Yearbook Of Cardiology, 2009, 373–376.
Fukuta, H., Sane, D. C., Brucks, S., & Little, W. C. (2005). Statin Therapy May Be Associated With Lower Mortality in Patients With Diastolic Heart Failure: A Preliminary Report. Circulation, 112(3), 357–363. doi: 10.1161/CIRCULATIONAHA.104.519876.
Inglis, S., McMurray, J., Böhm, M., Schaufelberger, M., van Veldhuisen, D., Lindberg, M. et al. (2010). Intermittent claudication as a predictor of outcome in patients with ischaemic systolic heart failure: analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA). European Journal Of Heart Failure, 12(7), 698–705. doi: 10.1093/eurjhf/hfq070.
van Veldhuisen, D., Cohen-Solal, A., Böhm, M., Anker, S., Babalis, D., Roughton, M. et al. (2009). Beta-Blockade With Nebivolol in Elderly Heart Failure Patients With Impaired and Preserved Left Ventricular Ejection Fraction. Journal Of The American College Of Cardiology, 53(23), 2150–2158. doi: 10.1016/j.jacc.2009.02.046.
Mulder, B., van Veldhuisen, D., Crijns, H., Böhm, M., Cohen-Solal, A., Babalis, D. et al. (2012). Effect of nebivolol on outcome in elderly patients with heart failure and atrial fibrillation: insights from SENIORS. European Journal Of Heart Failure, 14(10), 1171–1178. doi:10.1093/eurjhf/hfs100.
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