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Use of guideline-re...
Use of guideline-recommended medical therapy in patients with heart failure and chronic kidney disease : from physicians prescriptions to patients dispensations, medication adherence and persistence
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- Janse, Roemer J. (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Leiden Univ, Netherlands
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- Fu, Edouard L. (författare)
- Karolinska Inst, Sweden; Leiden Univ, Netherlands; Brigham & Womens Hosp, MA 02115 USA; Harvard Med Sch, MA 02115 USA
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- Dahlström, Ulf (författare)
- Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Benson, Lina (författare)
- Karolinska Institutet,Karolinska Inst, Sweden
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- Lindholm, Bengt (författare)
- Karolinska Institutet,Karolinska Inst, Sweden
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- van Diepen, Merel (författare)
- Leiden Univ, Netherlands
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- Dekker, Friedo W. (författare)
- Leiden Univ, Netherlands
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- Lund, Lars H. (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Carrero, Juan-Jesus (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Inst, Sweden
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- Savarese, Gianluigi (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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(creator_code:org_t)
- 2022-08-02
- 2022
- Engelska.
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 24:11, s. 2185-2195
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Abstract
Ämnesord
Stäng
- Aim Half of heart failure (HF) patients have chronic kidney disease (CKD) complicating their pharmacological management. We evaluated physicians and patients patterns of use of evidence-based medical therapies in HF across CKD stages. Methods and results We studied HF patients with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction enrolled in the Swedish Heart Failure Registry in 2009-2018. We investigated the likelihood of physicians to prescribe guideline-recommended therapies to patients with CKD, and of patients to fill the prescriptions within 90 days of incident HF (initiating therapy), to adhere (proportion of days covered >= 80%) and persist (continued use) on these treatments during the first year of therapy. We identified 31 668 patients with HFrEF (median age 74 years, 46% CKD). The proportions receiving a prescription for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNi) were 96%, 92%, 86%, and 68%, for estimated glomerular filtration rate (eGFR) >= 60, 45-59, 30-44, and <30 ml/min/1.73 m(2), respectively; for beta-blockers 94%, 93%, 92%, and 92%, for mineralocorticoid receptor antagonists (MRAs) 45%, 44%, 37%, 24%; and for triple therapy (combination of ACEi/ARB/ARNi + beta-blockers + MRA) 38%, 35%, 28%, and 15%. Patients with CKD were less likely to initiate these medications, and less likely to adhere to and persist on ACEi/ARB/ARNi, MRA, and triple therapy. Among stoppers, CKD patients were less likely to restart these medications. Results were consistent after multivariable adjustment and in patients with HFmrEF (n = 15 114). Conclusions Patients with HF and CKD are less likely to be prescribed and to fill prescriptions for evidence-based therapies, showing lower adherence and persistence, even at eGFR categories where these therapies are recommended and have shown efficacy in clinical trials.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- Heart failure; Chronic kidney disease; Renin-angiotensin-aldosterone-system inhibitors; Angiotensin receptor-neprilysin inhibitors; Beta-blockers; Mineralocorticoid receptor antagonists
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Till lärosätets databas
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Janse, Roemer J.
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Fu, Edouard L.
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Dahlström, Ulf
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Benson, Lina
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Lindholm, Bengt
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van Diepen, Mere ...
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visa fler...
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Dekker, Friedo W ...
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Lund, Lars H.
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Carrero, Juan-Je ...
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Savarese, Gianlu ...
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visa färre...
- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Kardiologi
- Artiklar i publikationen
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European Journal ...
- Av lärosätet
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Linköpings universitet
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Karolinska Institutet