ESC heart failure

2055-58221032023JunESC heart failureESC Heart FailReal-world safety of neurohormonal antagonist initiation among older adults following a heart failure hospitalization.162316341623-163410.1002/ehf2.14317To optimize guideline-directed medical therapy for heart failure, patients may require the initiation of multiple neurohormonal antagonists (NHAs) during and following hospitalization. The safety of this approach for older adults is not well established.We conducted an observational cohort study of 207 223 Medicare beneficiaries discharged home following a hospitalization for heart failure with reduced ejection fraction (HFrEF) (2008-2015). We performed Cox proportional hazards regression to examine the association between the count of NHAs initiated within 90 days of hospital discharge (as a time-varying exposure) and all-cause mortality, all-cause rehospitalization, and fall-related adverse events over the 90 day period following hospitalization. We calculated inverse probability-weighted hazard ratios (IPW-HRs) with 95% confidence intervals (CIs) comparing initiation of 1, 2, or 3 NHAs vs. 0. The IPW-HRs for mortality were 0.80 [95% CI (0.78-0.83)] for 1 NHA, 0.70 [95% CI (0.66-0.75)] for 2, and 0.94 [95% CI (0.83-1.06)] for 3. The IPW-HRs for readmission were 0.95 [95% CI (0.93-0.96)] for 1 NHA, 0.89 [95% CI (0.86-0.91)] for 2, and 0.96 [95% CI (0.90-1.02)] for 3. The IPW-HRs for fall-related adverse events were 1.13 [95% CI (1.10-1.15)] for 1 NHA, 1.25 [95% CI (1.21-1.30)] for 2, and 1.64 [95% CI (1.54-1.76)] for 3.Initiating 1-2 NHAs among older adults within 90 days of HFrEF hospitalization was associated with lower mortality and lower readmission. However, initiating 3 NHAs was not associated with reduced mortality or readmission and was associated with a significant risk for fall-related adverse events.© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.GoyalParagP0000-0001-7474-3737Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-365, New York, NY, 10063, USA.ZulloAndrew RARDepartment of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA.Department of Pharmacy, Lifespan-Rhode Island Hospital, Providence, RI, USA.GladdersBarbaraBThe Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.OnyebekeChukwumaCDepartment of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-365, New York, NY, 10063, USA.KwakMin JiMJDepartment of Internal Medicine, McGovern Medical School, Houston, TX, USA.AllenLarry ALADivision of Cardiology, University of Colorado Schools of Medicine, Aurora, CO, USA.LevitanEmily BEBDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.SaffordMonika MMMDepartment of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-365, New York, NY, 10063, USA.GilstrapLaurenLThe Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH, USA.engR01 AG065722AGNIA NIH HHSUnited StatesK76 AG064428AGNIA NIH HHSUnited StatesR01 AG045441AGNIA NIH HHSUnited StatesR21 AG061632AGNIA NIH HHSUnited StatesR01 AG012721AGNIA NIH HHSUnited StatesR24 AG064025AGNIA NIH HHSUnited StatesK23 HL142835HLNHLBI NIH HHSUnited StatesK23 HL142835HLNHLBI NIH HHSUnited StatesObservational StudyJournal ArticleResearch Support, Non-U.S. Gov't20230220