ArticleClinical cardiology2024
The effect of kidney function on guideline-directed medical therapy implementation and prognosis in heart failure with reduced ejection fraction.
Article in Clinical cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 10 citations in OpenAlex.
- Revisiting the obesity paradox in patients with heart failure with reduced ejection fraction in the light of contemporary guideline-directed medical therapy.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Temporal Trends and Predictors of Mortality in Heart Failure with Reduced Ejection Fraction: The Role of Renal Function and Left Ventricular Improvement.Journal of clinical medicine · 2026Article
- Device-based therapies in cardio-renal syndrome: a pathophysiology-driven approach to a complex bidirectional disease.Frontiers in cardiovascular medicine · 2026Review
- Integrating and Simplifying Evidence to Optimize Cardiorenal Guideline-Directed Therapies.Journal of clinical medicine · 2025Review
- Impact of Kidney Function on the Survival of Patients with Chagas Cardiomyopathy and Implantable Cardioverter Defibrillators.Journal of clinical medicine · 2025Article
- Therapeutic Consequences and Prognostic Impact of Multimorbidity in Heart Failure: Time to Act.Journal of clinical medicine · 2024Article
- The effect of kidney function on guideline-directed medical therapy implementation and prognosis in heart failure with reduced ejection fraction.Clinical cardiology · 2024Article
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Authors and funding
13 authors at 4 institutions in 3 countries.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundKidney dysfunction (KD) is a main limiting factor of applying guideline-directed medical therapy (GDMT) and reaching the recommended target doses (TD) in heart failure (HF) with reduced ejection fraction (HFrEF). HYPOTHESIS: We aimed to assess the success of optimization, long-term applicability, and adherence of neurohormonal antagonist triple therapy (TT:RASi [ACEi/ARB/ARNI] + βB + MRA) according to the KD after a HF hospitalization and to investigate its impact on prognosis.
methodsThe data of 247 real-world, consecutive patients were analyzed who were hospitalized in 2019-2021 for HFrEF and then were followed-up for 1 year. The application and the ratio of reached TD of TT at hospital discharge and at 1 year were assessed comparing KD categories (eGFR: ≥90, 60-89, 45-59, 30-44, <30 mL/min/1.73 m
resultsMajority of the patients received TT at hospital discharge (77%) and at 1 year (73%). More severe KD led to a lower application ratio (p < .05) of TT (92%, 88%, 80%, 73%, 31%) at discharge and at 1 year (81%, 76%, 76%, 68%, 40%). Patients with more severe KD were less likely (p < .05) to receive TD of MRA (81%, 68%, 78%, 61%, 52%) at discharge and a RASi (53%, 49%, 45%, 21%, 27%) at 1 year. One-year all-cause mortality (14%, 15%, 16%, 33%, 48%, p < .001), the ratio of all-cause rehospitalizations (30%, 35%, 40%, 43%, 52%, p = .028), and rehospitalizations for HF (8%, 13%, 18%, 20%, 38%, p = .001) were significantly higher in more severe KD categories.
conclusionsKD unfavorably affects the application of TT in HFrEF, however poorer mortality and rehospitalization rates among them highlight the role of the conscious implementation and up-titration of GDMT.
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