Association between cardiovascular medication and readmission in heart failure patients

Introduction and purpose: The aim of this large population-based cohort study is to compare hospital readmission rates of patients with heart failure (HF), prescribed core HF medications versus non-use in a real-world scenario. Angiotensin-converting-enzyme inhibitors (ACEI), angiotensin-receptor blockers (ARB), beta-blockers (BB) and mineralocorticoid-receptor antagonists (MRA) have demonstrated in randomized clinical trials in selected groups of HF patients to reduce the risk of readmission for HF. Diuretics, being indispensable for most patients with HF, are also investigated.

Methods and results: Medication at hospital discharge was determined on the basis of dispensing data from the Dutch PHARMO Database Network including 22,476 patients with a diagnosis of HF between 2001 and 2015. Median follow-up was 29.3 months. One third of all patients were readmitted for HF. Propensity
scores were calculated as a proxy for comorbidities and hazard ratios were adjusted (HRadj) accordingly. ACEI and ARB were not associated with readmission. Only 훽1-selective BB (sBBHF; bisoprolol, metoprolol and nebivolol) decreased risk of readmission (HRadj 0.94; 95%CI 0.90-0.99). Carvedilol, a 훽- and partly 훼1-blocking agent, (HRadj 1.25; 95%CI 1.14-1.38), MRA (HRadj 1.09; 95%CI 1.03-1.15) and diuretics (HRadj 1.14; 95%CI 1.06-1.23) were associated with an increased risk of readmission.

Conclusion: Based on our results, sBBHF should be preferred to the non-selective BB carvedilol, whereas they are considered equivalent in current guidelines. Further investigations are necessary to confirm our results in other real-world HF patients.