Initiation of Medical Therapy for Heart Failure Patients According to Kidney Function: A Danish Nationwide Study
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Methods: HF patients were identified from nationwide registers between 2014 and 2021. Information was obtained on eGFR, frailty status, and prescription of HF therapy. Patients were divided into three groups: normal kidney function (eGFR ≥ 60); moderate kidney dysfunction (GFR between 30 and 59); and severe kidney dysfunction (GFR < 30). Multivariate Cox models were used to study the association of eGFR, age, and frailty with use of HF therapy.
Results: Of the 42,320 HF patients included those with lower eGFR were significantly older and frailer (median age 74.3 years and 37.8% frail). The crude initiation rate of all three drug classes decreased with decreasing eGFR in a stepwise fashion. After adjusting for age and frailty status, initiation of MRA decreased with decreasing kidney function (moderate kidney function HR 0.80(95% CI 0.77– 0.84) and severe kidney function HR 0.24(0.21– 0.27)). After adjusting for age and frailty status, initiation of RAS inhibitor and BB was not significantly lower for moderate kidney dysfunction (HR 0.97(0.93– 1.02), and HR 1.06(0.97– 1.16, respectively)). Initiation of RAS inhibitor was significantly lower for patients with severe kidney dysfunction, HR 0.45(0.41– 0.50), but not for BB initiation HR 1.09(1.05– 1.14).
Conclusion: In a real-world HF cohort, patients with moderate and severe kidney dysfunction were associated with reduced use of MRA irrespective of age and frailty. Reduced use of RASi was associated with severe kidney dysfunction, whereas for patients with moderate kidney dysfunction, reduced use was mainly driven by aging and frailty. Reduced use of BB seemed to be primarily explained by aging and frailty.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Clinical Epidemiology |
| Vol/bind | 15 |
| Sider (fra-til) | 855-866 |
| Antal sider | 12 |
| ISSN | 1179-1349 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
Professor Pardeep S Jhund reports grants, Speakers fees, Advisory board fees, and work on clinical trials from AstraZeneca, Speakers fees, Advisory board fees, and work on clinical trials from Novartis, grants from Analog Devices, Advisory Board fees from Boehringer Ingelheim, Work on clinical trials from NovoNordisk, Work on clinical trials from Bayer AG, outside the submitted work; and Director GCTP Ltd. Professor John J V McMurray reports My employer, Glasgow University, has been paid by AstraZeneca (who market dapagliflozin) for my time spent as principal/ co-principal investigator of the DAPA-HF, DELIVER, DETERMINE trials and DAPA-Resist trial with dapagliflozin in heart failure and Steering Committee member for the DAPA-CKD trial with dapagliflozin in chronic kidney disease. These payments were made through a Consultancy with Glasgow University and I have not received personal payments in relation to this trial/this drug. My employer, Glasgow University, has been paid by Amgen for my time spent as Steering Committee member for the ATOMIC-HF, COSMIC-HF and GALACTIC-HF trials and meetings and other activities related to these trials. Amgen has also paid my travel and accommodation for some of these meetings/activities. These payments were made through a Consultancy with Glasgow University and I have not received personal payments in relation to these trials/this drug. My employer, Glasgow University, has been paid by Bayer for my time spent as coprincipal investigator of the FINEARTS trial with finerenone. These payments were made through a Consultancy with Glasgow University and I have not received personal payments in relation to these trials/drugs. My employer, Glasgow University, has been paid by Cardurion for my participation in a company advisory board about development in connection with drug development and design of clinical trials. My employer, Glasgow University, has been paid by Cytokinetics for my time spent as Steering Committee member for the GALACTIC-HF trial and meetings and other activities related to this trial. Cytokinetics has also paid my travel and accommodation for some of these meetings/ activities. These payments were made through a Consultancy with Glasgow University and I have not received personal payments in relation to these trials/this drug. My employer, Glasgow University, has been paid by GSK for my time spent as Steering Committee member for two trials, ASCEND-D and ASCEND-ND, using daprodustat, and meetings related to these trials. GSK has also paid my travel and accommodation for some of these meetings. These payments were made through a Consultancy with Glasgow University and I have not received personal payments in relation to these trials/ drugs. My employer, Glasgow University, has been paid by KBP Biosciences for my time spent scientific advisor to company to help guide clinical development in cardio-renal disease, inflammation & infection. My employer, Glasgow University, has been paid by Novartis for my time spent as co-principal investigator for the PARAGON-HF trial and Steering Committee member for PARADISE-MI, PERSPECTIVE and PARACHUTE-HF trials (all with sacubitril/ valsartan) and meetings related to these trials. Novartis has also paid my travel and accommodation for some of these meetings. These payments were made through a Consultancy with Glasgow University and I have not received personal payments from Novartis in relation to these trials/drugs. Personal fees from Alnylam, personal fees from Bayer, personal fees from BMS, personal fees from Ionis Pharma., personal fees from Novartis, personal fees from Regeneron Pharma., personal fees from River 2 Renal Corp., personal fees from Abbott, personal fees from Alkem Metabolics, personal fees from Astra Zeneca, personal fees from Blue Ocean Scientific Solutions Ltd., personal fees from Boehringer Ingelheim, personal fees from Canadian Medical and Surgical Knowledge, personal fees from Emcure Pharmaceuticals Ltd., personal fees from Eris Lifesciences, personal fees from European Academy of CME, personal fees from Hikma Pharmaceuticals, personal fees from Imagica Health, personal fees from Intas Pharma., personal fees from J.B. Chemicals & Pharma., personal fees from Lupin Pharma., personal fees from Medscape/Heart.Org., personal fees from ProfAdWise Communications, personal fees from Radcliffe Cardiology, personal fees from Sun Pharma., personal fees from The Corpus, personal fees from Translation Research Group, personal fees from Translational Medicine Academy, outside the submitted work. Professor Mark C Petrie reports grants, personal fees from SQ Innovation, grants, personal fees from Astra Zeneca, grants, personal fees from Novo Nordisk, grants, personal fees from Boehringer Ingelheim, grants from Teikoku, grants, personal fees from Novartis, grants, personal fees from Pharmacosmos, grants, personal fees from Vifor, outside the submitted work. Professor Lars Kober reports personal fees from Speakers fee from AstraZeneca, Bayer, Boehringer and Novartis, outside the submitted work. Professor Morten Schou reports lecture fees from Novo, Bohringer, Astra, and Novartis during the conduct of the study. The authors report no other conflicts of interest in this work.
Publisher Copyright:
© 2023 Zahir Anjum et al.
ID: 363063772