Evidence map›Paper›PMID 29423950›Full record

ArticlePharmacotherapy2018

Guideline-Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure.

Richard H Tran, Ahmed Aldemerdash, Patricia Chang, Carla A Sueta, Brystana Kaufman, Josephine Asafu-Adjei, Orly Vardeny, Eliza Daubert, Khalid A Alburikan, Anna M Kucharska-Newton and 2 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Pharmacotherapy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed
3.8field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 84 citations in OpenAlex.

  1. Effects of Losartan on Patients Hospitalized for Acute COVID-19: A Randomized Controlled Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024
    Trial
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  6. Observational
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  13. Assessing the application of American Heart Association (AHA) guidelines in the management of heart failure with reduced ejection fraction.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2025
    Article
  14. Article
  15. Article
  16. Article
  17. Myocardial Recovery in Cardiogenic Shock.Methodist DeBakey cardiovascular journal · 2024
    Review
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 5 institutions in 2 countries.

Richard H TranPharmaceutical Product Development, Morrisville, North Carolina.
Ahmed AldemerdashClinical Pharmacy, King Saudi University, Riyadh, Saudi Arabia.
Patricia ChangUNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Carla A SuetaUNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Brystana KaufmanGillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Josephine Asafu-AdjeiGillings School of Public Health, Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Orly VardenyMinneapolis VA Center for Chronic Disease Outcomes Research and University of Minnesota Medical School, Minneapolis, Minnesota.
Eliza DaubertUnited Therapeutics, Durham, North Carolina.
Khalid A AlburikanClinical Pharmacy, King Saudi University, Riyadh, Saudi Arabia.
Anna M Kucharska-NewtonGillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Sally C StearnsGillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Jo E RodgersUNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.ORCID 0000-0001-6016-0469
University of North Carolina at Chapel Hill · USSaudi Electronic University · SAPharmaceutical Product Development (United States) · USUnited Therapeutics (United States) · USUniversity of Minnesota · US

Funding

NHLBI NIH HHS HHSN268201100005CNHLBI NIH HHS HHSN268201100005GNHLBI NIH HHS HHSN268201100005INHLBI NIH HHS HHSN268201100006CNHLBI NIH HHS HHSN268201100007CNHLBI NIH HHS HHSN268201100007INHLBI NIH HHS HHSN268201100008CNHLBI NIH HHS HHSN268201100008INHLBI NIH HHS HHSN268201100009CNHLBI NIH HHS HHSN268201100009INHLBI NIH HHS HHSN268201100010CNHLBI NIH HHS HHSN268201100011CNHLBI NIH HHS HHSN268201100011INHLBI NIH HHS HHSN268201100012C
6 · The paper itself

Abstract

backgroundModification of guideline-directed medical therapy (GDMT) in hospitalized patients with heart failure (HF) has not been extensively evaluated.

methodsThe community surveillance arm of the Atherosclerosis Risk in Communities Study identified 6959 HF hospitalizations from 2005-2011. Predictors of GDMT modification and survival were assessed using multivariable logistic regression and Cox proportional hazards models.

resultsFor 5091 hospitalizations, patient mean age was 75 years, 53% were female, 69% were white, and 81% had acute decompensated heart failure (ADHF). Regarding ejection fraction (EF), 31% of patients had HF with reduced EF (HFrEF), 24% had HF with preserved EF (HFpEF), and 44% were missing EF values. At admission, 52% of patients received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), 66% β-blockers (BBs), 9% aldosterone-receptor antagonists, 16% digoxin, 10% hydralazine, and 29% nitrates. Modification of GDMT occurred in up to 23% of hospitalizations. Significant predictors of GDMT initiation included ADHF and HFrEF; discontinuation of medications was observed with select comorbidities. In HFrEF, initiation of any GDMT was associated with reduced 1-year all-cause mortality (adjusted hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.23-0.71) as was initiation of ACEI/ARBs, BBs, and digoxin. Discontinuation of any therapy versus maintaining GDMT was associated with greater mortality (HR 1.30, 95% CI 1.02-1.66). Similar trends were observed in HFpEF.

conclusionsOur study suggests that GDMT initiation is associated with increased survival, and discontinuation of therapy is associated with reduced survival in hospitalized patients with HF. Future studies should be conducted to confirm the impact of GDMT therapy modification in this population.

Indexed as

Practice Guidelines as TopicAgedAged, 80 and overCardiovascular AgentsComorbidityDisease ProgressionFemaleHeart FailureHospitalizationHumansMaleMiddle AgedProportional Hazards ModelsRetrospective StudiesStroke VolumeUnited StatesCardiovascular Agentsguideline-directed medical therapyheart failuremodificationmortalitypredictors

Identifiers

PMID29423950
PMCPMC5902433
OpenAlexW2793404518

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.