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논문 기본 정보

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저자정보
Ahn Min-Soo (Department of Internal Medicine Wonju College of Medicine Yonsei University Wonju Korea.) Yoo Byung-Su (Department of Internal Medicine Wonju College of Medicine Yonsei University Wonju Korea.) Son Jung-Woo (Department of Internal Medicine Wonju College of Medicine Yonsei University Wonju Korea.) Park Young Jun (Department of Internal Medicine Wonju College of Medicine Yonsei University Wonju Korea.) Lee Hae-Young (Department of Internal Medicine Seoul National University Hospital Seoul Korea.) Jeon Eun-Seok (Department of Internal Medicine Sungkyunkwan University College of Medicine Seoul Korea.) Kang Seok-Min (Department of Internal Medicine Yonsei University College of Medicine Seoul Korea.) Choi Dong-Ju (Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Korea.) Kim Kye Hun (Department of Internal Medicine Heart Research Center of Chonnam National University Gwangju Korea.) Cho Myeong-Chan (Department of Internal Medicine Chungbuk National University College of Medicine Cheongju Korea.) Kim Seong Yoon (MetroWest Medical Center Framingham MA USA.) Kang Dae Ryong (Department of Biostatics Wonju College of Medicine Yonsei University Wonju Korea.) Go Tae-Hwa (Department of Biostatics Wonju College of Medicine Yonsei University Wonju Korea.)
저널정보
대한의학회 Journal of Korean Medical Science Journal of Korean Medical Science Vol.36 No.40
발행연도
2021.10
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1 - 13 (13page)
DOI
10.3346/jkms.2021.36.e252

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Background: This study evaluated the relationship between guideline adherence for heart failure (HF) with reduced ejection fraction (HFrEF) at discharge and relevant clinical outcomes in patients with acute HF with preserved ejection fraction (HFpEF) with or without atrial fibrillation (AF). Methods: We analyzed Korean Acute Heart Failure Registry data for 707 patients with HFpEF with documented AF and 687 without AF. Guideline adherence was defined as good or poor according to the prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and mineralocorticoid receptor antagonists. Anticoagulation adherence was also incorporated for the AF group. Results: Among patients with normal sinus rhythm, those with poor guideline adherence had a reduced prevalence of comorbidities and favorable clinical characteristics when compared with those with good guideline adherence. Using inverse probability of treatment weighting (IPTW) to address the bias of nonrandom treatment assignment, good adherence was associated with a poor 60-day composite endpoint in the multivariable Cox model (weighted hazard ratio [wHR], 1.74; 95% confidence interval [CI], 1.01?3.00; P = 0.045). For patients with AF, baseline clinical characteristics were similar according to the degree of adherence. The IPTW-adjusted analysis indicated that good adherence was significantly associated with the 60-day composite endpoint (wHR, 0.47; 95% CI, 0.27?0.79; P = 0.005). In the analysis excluding warfarin, good adherence was associated with 60-day rehospitalization (wHR, 0.60; 95% CI, 0.37?0.98; P = 0.040), 1-year re-hospitalization (wHR, 0.67; 95% CI, 0.48?0.93; P = 0.018), and the composite endpoint (wHR, 0.77; 95% CI, 0.59?0.99; P = 0.041). Conclusion: Our findings indicate that good adherence to guidelines for HFrEF is associated with a better 60-day composite endpoint in patients with HFpEF with AF.
#Heart Failure #Atrial Fibrillation #Guideline Adherence

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참고문헌 (30)

참고문헌 신청
Bhatia RS / 2006 / Outcome of heart failure with preserved ejection fraction in a population-based study / N Engl J Med 355(3):260~269 google schola Owan TE / 2006 / Trends in prevalence and outcome of heart failure with preserved ejection fraction / N Engl J Med 355(3):251~259 google schola Ponikowski P / 2016 / 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure : The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC)developed with the special contribution of the Heart Failure Association(HFA)of the ESC / Eur Heart J 37(27):2129~2200 google schola Yancy CW / 2013 / 2013 ACCF/AHA guideline for the management of heart failure : executive summary : a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines / Circulation 128(16):1810~1852 google schola Chiang CE / 2012 / Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice : insight from the real-life global survey evaluating patients with atrial fibrillation international registry / Circ Arrhythm Electrophysiol 5(4):632~639 google schola

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