Assessing Guideline-Directed Medication Therapy for Heart Failure in End-Stage Renal Disease

B. Tate Cutshall, Benjamin Duhart, Jagannath Saikumar, Michael Samarin, Lydia Hutchison, Joanna Laizure

Research output: Contribution to journalArticle

Abstract

Background: Treatment of heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medication therapy (GDMT) consisting of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in combination with an indicated beta-blocker. There is concern that end-stage renal disease (ESRD) patients are not being prescribed GDMT. The study aim was to determine whether outcomes differ for patients with HFrEF and ESRD receiving GDMT compared to those not receiving GDMT. Materials and Methods: Adult patients with ESRD and HFrEF admitted to a tertiary teaching hospital over a 2-year period were included. Patients were categorized into GDMT or non-GDMT groups based on their home medications. The length of stay (LOS), mortality, and 30-day hospital readmissions were compared between groups. The incidence of hyperkalemia, hypotension and bradycardia were also evaluated. Results: A total of 109 patients were included: 88% African-American, 61% males, median age 63 (28-93) years with 25 in the GDMT group and 84 in the non-GDMT group. The LOS did not differ between the GDMT (5 days; 3-14) compared to the non-GDMT group (7 days; 3-28), P = 0.14. Thirty-day hospital readmission and in-hospital mortality were also similar. Hypotension occurred less frequently in the GDMT group compared to the non-GDMT group, 4% versus 27% (P = 0.01). Conclusions: Although there were no differences in the primary outcomes, the shorter LOS in the GDMT group may be clinically significant. The fact that most patients with ESRD and HFrEF were not receiving GDMT is a finding that requires further evaluation.

Original languageEnglish (US)
Pages (from-to)247-251
Number of pages5
JournalAmerican Journal of the Medical Sciences
Volume355
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Chronic Kidney Failure
Heart Failure
Group Psychotherapy
Guidelines
Therapeutics
Patient Readmission
Length of Stay
Hypotension
Hyperkalemia
Angiotensin Receptor Antagonists
Bradycardia
Hospital Mortality
Treatment Failure
Angiotensin-Converting Enzyme Inhibitors
Tertiary Care Centers
Teaching Hospitals
African Americans
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Assessing Guideline-Directed Medication Therapy for Heart Failure in End-Stage Renal Disease. / Cutshall, B. Tate; Duhart, Benjamin; Saikumar, Jagannath; Samarin, Michael; Hutchison, Lydia; Laizure, Joanna.

In: American Journal of the Medical Sciences, Vol. 355, No. 3, 01.03.2018, p. 247-251.

Research output: Contribution to journalArticle

Cutshall, B. Tate ; Duhart, Benjamin ; Saikumar, Jagannath ; Samarin, Michael ; Hutchison, Lydia ; Laizure, Joanna. / Assessing Guideline-Directed Medication Therapy for Heart Failure in End-Stage Renal Disease. In: American Journal of the Medical Sciences. 2018 ; Vol. 355, No. 3. pp. 247-251.
@article{17139f60a87b473dbabd1f15e87243c8,
title = "Assessing Guideline-Directed Medication Therapy for Heart Failure in End-Stage Renal Disease",
abstract = "Background: Treatment of heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medication therapy (GDMT) consisting of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in combination with an indicated beta-blocker. There is concern that end-stage renal disease (ESRD) patients are not being prescribed GDMT. The study aim was to determine whether outcomes differ for patients with HFrEF and ESRD receiving GDMT compared to those not receiving GDMT. Materials and Methods: Adult patients with ESRD and HFrEF admitted to a tertiary teaching hospital over a 2-year period were included. Patients were categorized into GDMT or non-GDMT groups based on their home medications. The length of stay (LOS), mortality, and 30-day hospital readmissions were compared between groups. The incidence of hyperkalemia, hypotension and bradycardia were also evaluated. Results: A total of 109 patients were included: 88{\%} African-American, 61{\%} males, median age 63 (28-93) years with 25 in the GDMT group and 84 in the non-GDMT group. The LOS did not differ between the GDMT (5 days; 3-14) compared to the non-GDMT group (7 days; 3-28), P = 0.14. Thirty-day hospital readmission and in-hospital mortality were also similar. Hypotension occurred less frequently in the GDMT group compared to the non-GDMT group, 4{\%} versus 27{\%} (P = 0.01). Conclusions: Although there were no differences in the primary outcomes, the shorter LOS in the GDMT group may be clinically significant. The fact that most patients with ESRD and HFrEF were not receiving GDMT is a finding that requires further evaluation.",
author = "Cutshall, {B. Tate} and Benjamin Duhart and Jagannath Saikumar and Michael Samarin and Lydia Hutchison and Joanna Laizure",
year = "2018",
month = "3",
day = "1",
doi = "10.1016/j.amjms.2017.11.008",
language = "English (US)",
volume = "355",
pages = "247--251",
journal = "American Journal of the Medical Sciences",
issn = "0002-9629",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Assessing Guideline-Directed Medication Therapy for Heart Failure in End-Stage Renal Disease

AU - Cutshall, B. Tate

AU - Duhart, Benjamin

AU - Saikumar, Jagannath

AU - Samarin, Michael

AU - Hutchison, Lydia

AU - Laizure, Joanna

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: Treatment of heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medication therapy (GDMT) consisting of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in combination with an indicated beta-blocker. There is concern that end-stage renal disease (ESRD) patients are not being prescribed GDMT. The study aim was to determine whether outcomes differ for patients with HFrEF and ESRD receiving GDMT compared to those not receiving GDMT. Materials and Methods: Adult patients with ESRD and HFrEF admitted to a tertiary teaching hospital over a 2-year period were included. Patients were categorized into GDMT or non-GDMT groups based on their home medications. The length of stay (LOS), mortality, and 30-day hospital readmissions were compared between groups. The incidence of hyperkalemia, hypotension and bradycardia were also evaluated. Results: A total of 109 patients were included: 88% African-American, 61% males, median age 63 (28-93) years with 25 in the GDMT group and 84 in the non-GDMT group. The LOS did not differ between the GDMT (5 days; 3-14) compared to the non-GDMT group (7 days; 3-28), P = 0.14. Thirty-day hospital readmission and in-hospital mortality were also similar. Hypotension occurred less frequently in the GDMT group compared to the non-GDMT group, 4% versus 27% (P = 0.01). Conclusions: Although there were no differences in the primary outcomes, the shorter LOS in the GDMT group may be clinically significant. The fact that most patients with ESRD and HFrEF were not receiving GDMT is a finding that requires further evaluation.

AB - Background: Treatment of heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medication therapy (GDMT) consisting of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in combination with an indicated beta-blocker. There is concern that end-stage renal disease (ESRD) patients are not being prescribed GDMT. The study aim was to determine whether outcomes differ for patients with HFrEF and ESRD receiving GDMT compared to those not receiving GDMT. Materials and Methods: Adult patients with ESRD and HFrEF admitted to a tertiary teaching hospital over a 2-year period were included. Patients were categorized into GDMT or non-GDMT groups based on their home medications. The length of stay (LOS), mortality, and 30-day hospital readmissions were compared between groups. The incidence of hyperkalemia, hypotension and bradycardia were also evaluated. Results: A total of 109 patients were included: 88% African-American, 61% males, median age 63 (28-93) years with 25 in the GDMT group and 84 in the non-GDMT group. The LOS did not differ between the GDMT (5 days; 3-14) compared to the non-GDMT group (7 days; 3-28), P = 0.14. Thirty-day hospital readmission and in-hospital mortality were also similar. Hypotension occurred less frequently in the GDMT group compared to the non-GDMT group, 4% versus 27% (P = 0.01). Conclusions: Although there were no differences in the primary outcomes, the shorter LOS in the GDMT group may be clinically significant. The fact that most patients with ESRD and HFrEF were not receiving GDMT is a finding that requires further evaluation.

UR - http://www.scopus.com/inward/record.url?scp=85044607494&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044607494&partnerID=8YFLogxK

U2 - 10.1016/j.amjms.2017.11.008

DO - 10.1016/j.amjms.2017.11.008

M3 - Article

C2 - 29549927

AN - SCOPUS:85044607494

VL - 355

SP - 247

EP - 251

JO - American Journal of the Medical Sciences

JF - American Journal of the Medical Sciences

SN - 0002-9629

IS - 3

ER -