Differences in ischemic versus non-ischemic heart failure on guideline adherence and clinical outcomes in heart failure with reduced ejection fraction: subgroup analysis for the TRANS-HF study

초록

Background: Patients with ischemic heart failure are less likely to achive recov-ery and are at a higher risk of mortality and adverse events compared tothose with non-ischemic patients. However, real-world data on the adherence toguideline-directed medical therapy(GDMT) in ischemic heart failure and its relation-ship with clinical outcomes remain limited. Methods: This is a post hoc analysis of the TRANS-HF study included patients hos-pitalized with acute decompensated heart failure. Patients were stratified accordingto the presence of ischemic heart disease. The primary outcomes were (1) theguideline adherence indicator (GAI), (2) changes in the Kansas City Cardiomyopa-thy Questionnaire Clinical Summary Score (KCCQ-CSS), and (3) the composite ofall-cause mortality and first admission for heart failure during two years of follow-up.Multivariable regression models were used to investigate the impact of ischemicheart disease on the outcomes of interest. Results: From the original cohort, 219 (22.3%) patients had ischemic heart disease,Compared to non-ischemic heart disease patients, those with ischemic heartdisease were older and had a higher proportion of comorbidities. Patients withischemic heart disease were less likely to achive a high GAI (OR 0.89; 95% CI 0.82,0.96; p = 0.005), and experienced smaller improvements in the KCCQ-CSS score (difference -5.36; 95% CI -9.95, -0.76; p < 0.001). Ischemic heart disease was alsoassociated with a significantly increased risk of the composite outcome of all-causemortality and first admission for heart failure during two years of follow-up (HR 1.41;95% CI 1.02, 1.94; p = 0.035). Conclusion: Adherence to GDMT is suboptimal in patients with ischemic heart dis-ease, which may contribute to poorer quality of life and worse long-term outcomes.Targeted strategies are required to enhance GDMT use in this high-risk population,potentially improving prognosis)