Introduction: Aggregating evidence reveals that guideline-recommended medical therapy (GRMT) including beta-blocker (BB), angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ACEi/ARB), and mineralocorticoid-receptor antagonist (MRA) improves mortality in heart failure patients with reduced left ventricular ejection fraction (LVEF). However, low blood pressure (BP) and impaired renal function often hinder the induction of GRMT in acute heart failure (AHF) patients, although this population is at high risk for adverse clinical events.
Purpose: We aimed to determine whether GRMT affects mortality in AHF patients with low BP and advanced renal dysfunction at discharge.
Methods: This study initially included 1,286 consecutive patients who were urgently hospitalized due to AHF and discharged alive. After the exclusion of patients with regular hemodialysis, patients with preserved LVEF (>40%), patients with systolic BP >100 mmHg at discharge and patients with estimated glomerular filtration ratio (eGFR) >45 mL/min/1.73m2, 112 AHF patients with reduced LVEF (<50%) and renal dysfunction (>grade 3b) presenting low BP (<100 mmHg) at discharge were ultimately enrolled in this study. Of them, 68 patients who received full medications including BB, ACEi/ARB and MRA (full-GRMT group), and 44 patients who received 1–2 medications among GRMT (partial-GRMT group) were respectively compared. The primary endpoint of this study was all-cause mortality.
Results: During observational period, 22 deaths (20%) were observed. Kaplan-Meier analysis showed that full-GRMT group had significantly lower all-cause mortality than partial-GRMT group (Log-rank, p=0.011, Figure). After adjustment for age, gender and BNP level at admission by Cox proportional hazards analysis, the hazard ratio (HR) for all-cause mortality was significantly lower in full-GRMT patients compared to partial-GRMT patients (HR 0.26, 95% confidence interval 0.07–0.90, P=0.033).
Conclusions: Full medications of GRMT at discharge had better long-term mortality than partial administration of GRMT in AHF patients with reduced LVEF, even they had advanced renal dysfunction and low BP at discharge.