Triple therapy at discharge from internal medicine wards in heart failure patients with reduced ejection fraction: results from an observational study

doi: 10.7417/CT.2018.2095

  • A. Fortini Internal Medicine, San Giovanni di Dio Hospital, Firenze
  • V. Verdiani Internal Medicine, Misericordia Hospital, Grosseto
  • G. Panigada Internal Medicine, Santi Cosma e Damiano Hospital, Pescia (Pistoia)
  • C. Angotti Internal Medicine, San Giovanni di Dio Hospital, Firenze
  • L. Masotti Internal Medicine, San Giuseppe Hospital, Empoli (Firenze), Italy

Abstract

Background
Guidelines recommend triple therapy (TT) with ACE inhibitors or ARBs, beta-blockers and mineralcorticoid receptor antagonists in symptomatic heart failure patients with ejection fraction < 35 % (HFrEF). Nevertheless, many patients remain untreated. This study was aimed to evaluate the use of TT in HFrEF patients discharged from internal medicine wards of Tuscany, Italy.


Methods and Results
We analyzed the database of a multicenter observational study which included 770 patients consecutively hospitalized for HF in 32out of 36 Internal Medicine Units of Tuscany, Italy. The value of ejection fraction was available in 490 of the 725 patients discharged alive. Of the 117 patients with HFrEF, only 46 (39.3%) were on TT at discharge while 71 (60.7%) were not. In the latter group we observed a significantly greater percentage of patients with cognitive deficit (25.3% vs 10.8%, p=0.05). In the same group there was a slightly greater percentage of patients with hypertension (61.9% vs 58.6%), diabetes (43.6% vs 36.9%), GFR<60 ml/min (74.6% vs 67.3%), anemia (52.1% vs 45.6%) and atrial fibrillation (40.8% vs 34.7%), but the differences were not statistically significant.


Conclusions
These results indicate that TT is underutilized in internal medicine wards of Tuscany. Untreated patients had a greater rate of cognitive deficit and were probably sicker, more complex and fragile

Published
2018-12-12
How to Cite
FORTINI, A. et al. Triple therapy at discharge from internal medicine wards in heart failure patients with reduced ejection fraction: results from an observational study. La Clinica Terapeutica, [S.l.], v. 169, n. 6, p. e287 - e291, dec. 2018. ISSN 1972-6007. Available at: <http://www.clinicaterapeutica.it/ojs/index.php/ClinicaTerapeutica/article/view/288>. Date accessed: 23 mar. 2019.