Physicians' Academy for Cardiovascular Education

Suboptimal use of evidence-based medical therapies in patients with HFrEF and CKD

Kidney Function and Outcomes in Patients Hospitalized with Heart Failure

Literature - Patel RB, Fonarow GC, Greene SJ et al. - J Am Coll Cardiol. 2021 May 4;S0735-1097(21)04968-8. doi: 10.1016/j.jacc.2021.05.002.

Introduction and methods

Not much is known about how frequently evidence-based medical therapies are prescribed for patients with HFrEF and CKD. This study evaluated care patterns and outcomes in adult patients hospitalized for HF across the spectrum of kidney function in the Get With The Guidelines-Heart Failure (GWTG-HF) registry.

The GWTG-HF program prospectively collects information about patients with a primary discharge diagnosis of HF from participating centers in the US [1]. The primary analytic cohort included 365 494 adult patients (mean age 72±15 years), hospitalized for HF between January 1, 2014 and September 30, 2019 across 418 GWTG-HF sites. Patients were categorized based on EF criteria (HFrEF: EF ≤40%, HFmrEF: EF 41-49%, and HFpEF: EF ≥50%) and based on eGFR at discharge (>90, 60 to<90, 45 to <60, 30 to <45, <30 mL/min/1.73m², and dialysis).

In-hospital mortality was assessed in the primary analytic cohort according to admission eGFR. Achievement of quality measures among HFrEF patients was assessed in a secondary analytic cohort that excluded patients with EF >40% and patients with missing EF data, leaving 157,439 participants from 407 sites. The primary metrics of interest for patients with HFrEF were: use of ACEi, ARB or ARNI, β-blocker, and/or MRA at discharge, or prescription of triple therapy (ACEi/ARB/ARNI + β-blocker + MRA).

Main results


In patients hospitalized for HF, lower admission eGFR was significantly associated with higher in-hospital mortality in a graded fashion. Moreover, this study showed that prescription rates of evidence-based medical therapies are suboptimal in patients with HFrEF and CKD, also at levels of eGFR where therapies are not contraindicated by kidney dysfunction.


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Find this article online at J Am Coll Cardiol.

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