Effectiveness of guideline-consistent heart failure drug prescriptions at hospital discharge on 1-year mortality: Results from the EPICAL2 cohort study

Busson, A; Thilly, Nathalie; Laborde‐Castérot, Hervé; Alla, François; Messikh, Ziyad; Clerc‐Urmès, Isabelle; Mebazaa, Alexandre; Soudant, Marc; Agrinier, Nelly

doi:10.1016/j.ejim.2017.12.005

Cited by 7 publications

(10 citation statements)

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“…The EPICAL2 study was an observational, prospective, multicenter, and population‐based cohort study, previously described in detail elsewhere . Briefly, the cohort involved 21 volunteer hospitals all over the Lorraine region of northeast France (population 2 350 000 according to the 2012 census), which included patients hospitalized for acute HF or acute HF developing during hospitalization from October 2011 to October 2012.…”

Section: Methodsmentioning

confidence: 99%

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Adherence to ESC guideline‐recommended medications over a 36‐month follow‐up period after hospitalization for heart failure: Results from the EPICAL2 cohort study

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Agrinier

Alla

et al. 2019

Pharmacoepidemiology and Drug

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Purpose The purpose of the study is to describe the trajectories of oral medication prescriptions in patients with heart failure with reduced ejection fraction (HFrEF) over 3 years after discharge from hospitalization for heart failure. We then evaluated the adherence of these prescriptions to the European Society of Cardiology (ESC) guideline‐recommended medications and identified patient characteristics associated with nonadherence. Methods We used data from the EPICAL2 cohort study. HFrEF patients who had completed prescriptions at discharge and at 6‐month follow‐up were included and followed for 36 months. The following medication agents were considered adherent to guidelines: renin‐angiotensin system (RAS) blockers [angiotensin‐converting enzyme inhibitor (ACEI) or an angiotensin‐receptor blocker (ARB)] plus a β‐blocker (BB) or RAS blocker plus BB plus mineralocorticoid receptor antagonists (MRAs). The evolution of drug prescriptions and the adherence to ESC guidelines were assessed by using sequence analysis and clustering approaches. Patient characteristics associated with nonadherence were identified by logistic regression analyses. Results A typology of four therapeutic clusters was obtained, among which two clusters were adherent to recommendations and two were not. The adherent clusters consisted of bitherapy (RAS blockers‐BB) and tritherapy (RAS blockers‐BB‐MRA) for about 64% of patients and remain stable over time. The nonadherent clusters consisted of nonprescription of BB for about 22% of patients or nonprescription of RAS blocker for about 14%. The main reason for nonprescription of BB was a concomitant obstructive airway disease (asthma or COPD) but was a concomitant chronic kidney disease for nonprescription of RAS blocker. Conclusion Adherence to guideline‐recommended medications while being hospitalized is of great importance because prescriptions are quite stable over time after discharge. HFrEF patients are most often older, with various comorbidities, such as chronic kidney disease or asthma/COPD, which importantly limit physicians' ability to prescribe recommended drugs, leading to suboptimal adherence to guidelines.

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Section: Methodsmentioning

confidence: 99%

“…The EPICAL2 study was an observational, prospective, multicenter, and population-based cohort study, previously described in detail elsewhere. 14 consecutive adults with HF. Patients were then followed up for 3 years after discharge from the index hospitalization or until death if it occurred first.…”

Section: Setting Design and Populationmentioning

confidence: 99%

Adherence to ESC guideline‐recommended medications over a 36‐month follow‐up period after hospitalization for heart failure: Results from the EPICAL2 cohort study

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Agrinier

Alla

et al. 2019

Pharmacoepidemiology and Drug

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“…The methods of recruitment and patient characteristics have been already published elsewhere [7,8]. In brief, this cohort (EPICAL2, NCT02880358) included 2254 patients who were hospitalized in the Lorraine region of northeast France (2,350,000 inhabitants, according to the 2012 census) for acute HF between October 2011 and October 2012 and followed for 1 year after hospital discharge.…”

Section: Participantsmentioning

confidence: 99%

“…The type of statin could be any of the following: rosuvastatin, pravastatin, atorvastatin, simvastatin, lovastatin, fluvastatin, cerivastatin and pitavastatin. Besides sociodemographic and clinical data, treatment data were collected by standardized forms at inclusion, during the index hospitalization and at discharge [7,8]. The baseline characteristics of included patients are reported in Table 1.…”

Section: Participantsmentioning

confidence: 99%

“…These variables were age, gender, hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class III or IV, increased brain natriuretic peptide (BNP) or N-terminal prohormone of brain natriuretic peptide (NT-proBNP), hemoglobin level, alcohol abuse, smoking status, previous history of HF, hospital stay duration, angina, history of stroke/transient ischemic attack (TIA), arrhythmias, dyslipidemia, history of acute coronary syndrome, chronic obstructive pulmonary disease (COPD)/asthma, diabetes, chronic kidney disease, malignant hemopathies or any cancer, and usual treatment with BBs, ACE-i, and spironolactone. We included the prescription of BBs, ACE-i, and Table 1 Characteristics of included HF patients according to treatment with statins ACE-i angiotensin-converting-enzyme inhibitor, ARB angiotensin receptor blocker, BBs beta-blockers, BMI body mass index, BNP brain natriuretic peptide, COPD chronic obstructive pulmonary disease, HF heart failure, LVEF left ventricular ejection fraction, NT-proBNP N-terminal prohormone of brain natriuretic peptide, NYHA New York Heart Association classification, SD standard deviation, TIA transient ischemic attack a Values are n (%) unless otherwise stated b Deleted in models for collinearity c BNP > 400 pg/mL or NT-proBNP > 450 pg/mL in patients < 50 years; NT-proBNP > 900 pg/mL in patients 50-75 years; NT-proBNP > 1800 pg/mL in patients > 75 years [7,9] spironolactone among the selected variables because they are known to be associated with a better prognosis [7,9]. We defined the variable "increased BNP or NT-proBNP (pg/mL)" based on the literature [8,10] at the time of the EPICAL2 recruitment phase: BNP > 400 pg/mL or NT-proBNP > 450 pg/mL in patients < 50 years, NT-proBNP > 900 pg/mL in patients 50-75 years, and NT-proBNP > 1800 pg/mL in patients > 75 years.…”

Section: Variables Selectionmentioning

confidence: 99%

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Effects of Statins to Reduce All-Cause Mortality in Heart Failure Patients: Findings from the EPICAL2 Cohort Study

Al-Gobari

Agrinier

Soudant

et al. 2019

Am J Cardiovasc Drugs

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Introduction The addition of statins to standard care in heart failure (HF) patients remains controversial in clinical practice. Large-scale clinical trials failed to show mortality benefits, but uncertainty persists in real-world settings. Objective We evaluated whether the prescription of statins at hospital discharge is associated with a reduction in all-cause mortality at up to 1 year of follow-up in HF patients. Methods We analyzed data from Epidémiologie et Pronostic de l'Insuffisance Cardiaque Aiguë en Lorraine (EPICAL2) cohort study of 2254 hospitalized acute HF patients who were admitted to 21 hospitals located in northeast France for acute HF between October 2011 and October 2012 and who received statins at discharge compared with patients who did not. We used propensity score matching and instrumental variable analyses to estimate the treatment effects of statins, and a multivariable Cox proportional-hazards model to examine survival with statin use, adjusting for patient demographics, HF characteristics, medical history, comorbidities, drug treatment and other known potential confounders. We plotted Kaplan-Meier survivor curves, and used log-rank test to determine the equality of survivor functions. Results We included 2032 patients in this investigation: 919 (45%) in the statin-treated group and 1113 (55%) in the control group. The estimated average statin-treatment effects for all-cause mortality in HF failed to demonstrate a significant effect on mortality [Z = − 1.73, 95% confidence interval (CI) − 0.11 to 0.007, p value = 0.083, and Z = − 0.95, 95% CI − 1.34 to 0.46, p value = 0.34] for propensity score matching and instrumental variable analyses, respectively. Moreover, the Cox proportional-hazards model showed that statin prescription was not significantly associated with the rate of death (hazard ratio = 0.85, 95% CI 0.66-1.11, p value = 0.26), adjusted for all confounders. Conclusion In patients with HF (and reduced or preserved ejection fraction), the prescription of statins did not appear to be associated with better survival after 1 year of follow-up in the EPICAL2 cohort. We cannot exclude that a subpopulation of HF patients may have some benefits compared with the whole HF population or that there might be a lack of power to show such effect. Clinical Trial Registration NCT02880358.

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Prognostic factors of readmission and mortality after first heart failure hospitalization: results from EPICAL2 cohort

et al. 2022

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Aims We aimed to identify prognostic individual factors in patients with first acute heart failure (HF) hospitalization, considering both death and readmission as part of the natural history of HF. Methods and results We used data from the observational, prospective, multicentre EPICAL2 cohort study from which we selected incident cases of acute HF alive at discharge. We relied on an illness‐death model to identify prognostic factors on first readmission and on mortality before and after readmission. In 451 patients hospitalized for first acute HF, we observed within the year after discharge, 23 (5.1%) deaths before readmission and 270 (59.9%) first readmissions, of which 60 (22.2%) were followed by death of any cause. First, among patient characteristics, only Charlson index ≥ 8 was associated with first readmission [adjusted hazard ratio (aHR) = 1.6, 95% confidence interval (CI) (1.1–2.3), P = 0.011]. Second, Charlson index ≥ 8 [aHR = 4.2, 95% CI (1.2–14.8), P = 0.025], low blood pressure (BP) [aHR = 12.2, 95% CI (1.9–79.6), P = 0.009], high BP [aHR = 6.9, 95% CI (1.3–36.4), P = 0.023], and prescription of recommended dual or triple HF therapy at index discharge [aHR = 0.2, 95% CI (0.1–0.7), P = 0.014] were associated with mortality before any readmission. Third, Charlson index ≥ 8 [aHR = 2.4, 95% CI (1.1–5.6), P = 0.037] and the time to first readmission (per 30 days additional) [aHR = 1.2; 95% CI (1.1–1.4), P = 0.007] were associated with mortality after readmission. Conclusions Regardless of the prognostic state considered, we showed that comorbidities are of critical prognostic value in a real‐world cohort of incident HF cases. This argues in favour of multidisciplinary care in HF.

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Effectiveness of guideline-consistent heart failure drug prescriptions at hospital discharge on 1-year mortality: Results from the EPICAL2 cohort study

Cited by 7 publications

References 28 publications

Adherence to ESC guideline‐recommended medications over a 36‐month follow‐up period after hospitalization for heart failure: Results from the EPICAL2 cohort study

Adherence to ESC guideline‐recommended medications over a 36‐month follow‐up period after hospitalization for heart failure: Results from the EPICAL2 cohort study

Effects of Statins to Reduce All-Cause Mortality in Heart Failure Patients: Findings from the EPICAL2 Cohort Study

Prognostic factors of readmission and mortality after first heart failure hospitalization: results from EPICAL2 cohort

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