The Impact of Midodrine on Guideline-Directed Medical Therapy in Patients Admitted With Systolic Heart Failure.

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Pharmacology Pub Date : 2024-04-01 DOI:10.1097/FJC.0000000000001532

Christopher B Scoma, Dae Hyun Lee, David Money, Gerry Eichelberger, Ahsan Usmani, Adam J Cohen, Joel Fernandez

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Abstract

Abstract: Midodrine is occasionally used off-label to treat hypotension associated with advanced heart failure (HF); however, its association with changes in prescription of guideline-directed medical therapy (GDMT) is unknown. We sought to evaluate the effect of midodrine on the GDMT prescription pattern and clinical outcomes of patients with decompensated systolic HF. We retrospectively identified 114 patients admitted to our hospital in 2020 with decompensated systolic HF who were prescribed midodrine on discharge and compared them with 358 patients with decompensated systolic HF who were not prescribed midodrine. At 6 months, the midodrine group had more initiation or up-titration of beta blockers, renin-angiotensin-aldosterone system inhibitors, and sodium-glucose cotransporter-2 inhibitors compared with the nonmidodrine group. Survival at 6 months was similar between the 2 groups, but the midodrine group had more frequent rehospitalization for HF. Our findings suggest that midodrine is associated with improved GDMT in patients with decompensated HF but may be associated with worse prognosis.

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米多君对收缩性心力衰竭入院患者指导性药物治疗的影响

背景：米多君偶尔会在标签外用于治疗晚期心力衰竭引起的低血压。其与指导性医疗疗法（GDMT）处方变化的关系尚不清楚：我们试图评估米多君对失代偿收缩性心力衰竭患者 GDMT 处方模式和临床疗效的影响：我们对 2020 年入住本院的所有失代偿收缩性心力衰竭患者进行了回顾性鉴定，这些患者在出院时均被处方米多君。将他们与未服用米多君的失代偿收缩性心力衰竭患者进行比较。收集了基线特征、GDMT调整和临床结果：米多君组共有114名患者符合纳入标准，与对照组的358名患者进行了比较。6个月后，米多君组开始使用或增加β受体阻滞剂（25.5% vs 15.0%；P=0.023）、肾素-血管紧张素-醛固酮系统（RAAS）抑制剂（35.8% vs 24.8%；P=0.041) 和钠-葡萄糖共转运体-2 抑制剂 (SGLT2i) (19.8% vs 11.2%; p=0.04)。两组患者6个月的存活率相似，但米多君组患者因心力衰竭再次入院的频率更高：结论：米多君是收缩性心力衰竭患者的常用处方药；服用米多君的患者往往心力衰竭更严重，6个月的临床预后更差。然而，与未服用米多君的患者相比，服用米多君的患者在6个月后的GDMT起始和升级治疗效果更好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Pharmacology 医学-心血管系统

CiteScore

5.10

自引率

3.30%

发文量

367

审稿时长

1 months

期刊介绍： Journal of Cardiovascular Pharmacology is a peer reviewed, multidisciplinary journal that publishes original articles and pertinent review articles on basic and clinical aspects of cardiovascular pharmacology. The Journal encourages submission in all aspects of cardiovascular pharmacology/medicine including, but not limited to: stroke, kidney disease, lipid disorders, diabetes, systemic and pulmonary hypertension, cancer angiogenesis, neural and hormonal control of the circulation, sepsis, neurodegenerative diseases with a vascular component, cardiac and vascular remodeling, heart failure, angina, anticoagulants/antiplatelet agents, drugs/agents that affect vascular smooth muscle, and arrhythmias. Appropriate subjects include new drug development and evaluation, physiological and pharmacological bases of drug action, metabolism, drug interactions and side effects, application of drugs to gain novel insights into physiology or pathological conditions, clinical results with new and established agents, and novel methods. The focus is on pharmacology in its broadest applications, incorporating not only traditional approaches, but new approaches to the development of pharmacological agents and the prevention and treatment of cardiovascular diseases. Please note that JCVP does not publish work based on biological extracts of mixed and uncertain chemical composition or unknown concentration.