Factors Associated with Sub-Target Dose of Renin-Angiotensin Blockage among Chronic Heart Failure with Reduced Ejection Fraction Patients

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Kanungjitr Tissakool
Somratai Vadcharavivad
Aekarach Ariyachaipanich
Watsit Chaipatiwat
Yotsaya Kunlamas


BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor-neprilysin inhibitors (ARNIs), or angiotensin receptor blockers (ARBs) are recommended by the guidelines for all patients with chronic heart failure with reduced ejection fraction. However, in real-world data, most patients are unable to achieve the targeted dose of these medications. In Thailand, there has been no study conducted on the factors associated with sub-target doses of ACEIs/ARBs/ARNI.

OBJECTIVES: To analyze the factors associated with heart failure with reduced ejection fraction patients who have received sub-target doses of ACEIs/ARBs/ARNI among the Thai population.

METHODS: This retrospective cohort study was conducted in Trat and Phrapokklao Hospitals from January 2016 to December 2020. Out-Patient Clinic medical records of those with heart failure with reduced ejection fraction were reviewed using case record forms. Thirteen factors were analyzed by logistic regression to determine the association with the sub-target dose group.

RESULTS: A total of 396 patients were included in this study, and 289 patients were treated with the sub-target dose. After adjusting all factors, it was found that NYHA class III/IV was associated with the sub-target dose (odds ratio 1.75; 95%CI 1.06-2.88, p = 0.03). Receiving over 50% of the target dose of Beta-blockers was the protective factor (odd ratios 0.37; 95%CI 0.23-0.61, p<0.001).

CONCLUSIONS: NYHA class III/IV was the factor that increased the risk of receiving the sub-target dose; however, receiving ≥50% of the target dose of Beta-blockers was the factor that decreased the risk. Furthermore, both of these factors were modifiable.

ClinicalTrials.gov Identifier, NCT06382571

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Original Article


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