• Etienne Gayat, Mattia Arrigo, Simona Littnerova, Naoki Sato, Jiri Parenica, Shiro Ishihara, Jindrich Spinar, Christian Müller, Veli-Pekka Harjola, Johan Lassus, Òscar Miró, Aldo P Maggioni, Khalid F AlHabib, Dong-Ju Choi, Jin Joo Park, Yuhui Zhang, Jian Zhang, James L Januzzi, Katsuya Kajimoto, Alain Cohen-Solal, Alexandre Mebazaa, and GREAT Network.
• Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot and INSERM UMR-S 942, Paris, France.
• Eur. J. Heart Fail. 2018 Feb 1; 20 (2): 345-354.

AimsHeart failure oral therapies (HFOTs), including beta-blockers (BB), renin-angiotensin system inhibitors (RASi) and mineralocorticoid receptor antagonists, administered before hospital discharge after acute heart failure (AHF) might improve outcome. However, concerns have been raised because early administration of HFOTs may worsen patient's condition. We hypothesized that HFOTs at hospital discharge might be associated with better post-discharge survival.Methods And ResultsThe study population was composed of 19 980 AHF patients from the GREAT registry. The primary and secondary outcomes were 90-day and 1-year all-cause mortality, respectively. Survival was estimated with univariate and covariate-adjusted Cox proportional hazards regression models for the whole population and after propensity-score matching. HFOTs at discharge were consistently associated with no excess mortality in the unadjusted and adjusted analyses of the whole and matched cohorts. In the matched cohort, BB and RASi at discharge were associated with lower 90-day mortality risks compared to the respective untreated groups [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.46-0.69; and HR 0.53, 95% CI 0.42-0.66, respectively]. The favourable associations of BB and RASi at discharge with 90-day mortality were present in many subgroups including patients with reduced or preserved left ventricular ejection fraction and persisted up to 1 year after discharge. The combination of RASi and BB was associated with an even lower risk of death than RASi or BB alone.ConclusionsAdministration of HFOTs at hospital discharge is associated with better survival of AHF patients.© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

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