Journal of Clinical Medicine (Nov 2022)

Combined Neuro-Humoral Modulation and Outcomes in Patients with Chronic Heart Failure and Mildly Reduced or Preserved Ejection Fraction

  • Mauro Gori,
  • Marco Marini,
  • Lucio Gonzini,
  • Samuela Carigi,
  • Luisa De Gennaro,
  • Piero Gentile,
  • Giuseppe Leonardi,
  • Francesco Orso,
  • Denitza Tinti,
  • Donata Lucci,
  • Massimo Iacoviello,
  • Alessandro Navazio,
  • Enrico Ammirati,
  • Annamaria Municinò,
  • Manuela Benvenuto,
  • Leonarda Cassaniti,
  • Luigi Tavazzi,
  • Aldo Pietro Maggioni,
  • Renata De Maria

DOI
https://doi.org/10.3390/jcm11226627
Journal volume & issue
Vol. 11, no. 22
p. 6627

Abstract

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Pharmacotherapy of chronic heart failure with mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF) remains challenging. We aimed to assess whether combined neuro-humoral modulation (NHM) (renin–angiotensin system inhibitors, betablockers, mineralocorticoid receptor antagonists) was differentially associated with outcome according to phenotype and age groups. Between 1999 and 2018 we recruited in a nationwide cardiology registry 4707 patients (HFmrEF n = 2298, HFpEF n = 2409) from three age groups: trend = 0.001); the reverse was observed among HFpEF (ptrend = 0.005). Triple NHM increased over time in both phenotypes (all p for trend p = 0.032) and HFpEF (HR 0.700, 95%CI 0.499–0.983, p = 0.039), with no interaction between NHM treatment and age groups (p = 0.58, p = 0.80, respectively). In a cardiology setting, among HF outpatients with EF > 40%, triple NHM treatment increased over time and was associated with better patient outcomes.

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