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Frailty, Guideline-Directed Medical Therapy, and Outcomes in HFrEF: From the GUIDE-IT Trial.

Publication ,  Journal Article
Khan, MS; Segar, MW; Usman, MS; Singh, S; Greene, SJ; Fonarow, GC; Anker, SD; Felker, GM; Januzzi, JL; Butler, J; Pandey, A
Published in: JACC Heart Fail
April 2022

OBJECTIVES: In this study, we sought to evaluate the association of frailty with the use of optimal guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF). BACKGROUND: The burden of frailty in HFrEF is high, and the patterns of GDMT use according to frailty status have not been studied previously. METHODS: A post hoc analysis of patients with HFrEF enrolled in the GUIDE-IT (Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure) trial was conducted. Frailty was assessed with the use of a frailty index (FI) using a 38-variable deficit model, and participants were categorized into 3 groups: class 1: nonfrail, FI <0.21); class 2: intermediate frailty, FI 0.21-0.31), and class 3: high frailty, FI >0.31). Multivariate-adjusted Cox models were used to study the association of frailty status with clinical outcomes. Use of optimal GDMT over time (beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists) across frailty strata was assessed with the use of adjusted linear and logistic mixed-effect models. RESULTS: The study included 879 participants, of which 56.3% had high frailty burden (class 3 FI). A higher frailty burden was associated with a significantly higher risk of HF hospitalization or death in adjusted Cox models: high frailty vs nonfrail HR: 1.76, 95% CI: 1.20-2.58. On follow-up, participants with high frailty burden also had a significantly lower likelihood of achieving optimal GDMT: high frailty vs non-frail GDMT triple therapy use at study end: 17.7% vs 28.4%; P interaction, frailty class × time <0.001. CONCLUSIONS: Patients with HFrEF with a high burden of frailty have a significantly higher risk for adverse clinical outcomes and are less likely to be initiated and up-titrated on an optimal GDMT regimen.

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

April 2022

Volume

10

Issue

4

Start / End Page

266 / 275

Location

United States

Related Subject Headings

  • Stroke Volume
  • Mineralocorticoid Receptor Antagonists
  • Humans
  • Heart Failure
  • Frailty
  • Angiotensin-Converting Enzyme Inhibitors
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Khan, M. S., Segar, M. W., Usman, M. S., Singh, S., Greene, S. J., Fonarow, G. C., … Pandey, A. (2022). Frailty, Guideline-Directed Medical Therapy, and Outcomes in HFrEF: From the GUIDE-IT Trial. JACC Heart Fail, 10(4), 266–275. https://doi.org/10.1016/j.jchf.2021.12.004
Khan, Muhammad Shahzeb, Matthew W. Segar, Muhammad Shariq Usman, Sumitabh Singh, Stephen J. Greene, Gregg C. Fonarow, Stefan D. Anker, et al. “Frailty, Guideline-Directed Medical Therapy, and Outcomes in HFrEF: From the GUIDE-IT Trial.JACC Heart Fail 10, no. 4 (April 2022): 266–75. https://doi.org/10.1016/j.jchf.2021.12.004.
Khan MS, Segar MW, Usman MS, Singh S, Greene SJ, Fonarow GC, et al. Frailty, Guideline-Directed Medical Therapy, and Outcomes in HFrEF: From the GUIDE-IT Trial. JACC Heart Fail. 2022 Apr;10(4):266–75.
Khan, Muhammad Shahzeb, et al. “Frailty, Guideline-Directed Medical Therapy, and Outcomes in HFrEF: From the GUIDE-IT Trial.JACC Heart Fail, vol. 10, no. 4, Apr. 2022, pp. 266–75. Pubmed, doi:10.1016/j.jchf.2021.12.004.
Khan MS, Segar MW, Usman MS, Singh S, Greene SJ, Fonarow GC, Anker SD, Felker GM, Januzzi JL, Butler J, Pandey A. Frailty, Guideline-Directed Medical Therapy, and Outcomes in HFrEF: From the GUIDE-IT Trial. JACC Heart Fail. 2022 Apr;10(4):266–275.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

April 2022

Volume

10

Issue

4

Start / End Page

266 / 275

Location

United States

Related Subject Headings

  • Stroke Volume
  • Mineralocorticoid Receptor Antagonists
  • Humans
  • Heart Failure
  • Frailty
  • Angiotensin-Converting Enzyme Inhibitors
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology