Association of HF medical treatment with VA
Comparing patients with documented VA to those without VA, revealed
similar baseline characteristics, except for lower prevalence of
Diabetes Mellitus (DM) and longer follow-up among the VA group (Table
1). Crude medication prescription was not associated with VA, nor was
the number of guideline-based medications (2.3±0.83 for VA vs. 2.25±0.7
without VA; p =0.8). Patients taking all 3 guideline-recommended
medication groups did not have less VA (p 0.33). The patients with VA
were treated with significantly lower doses of BB compared to those
without VA (23.9±19% versus 35.5±27% target dose; p=0.012). There was
no significant difference in AA or MRA doses between the VA and no VA
groups (Table 1).
Incident VA was significantly less common among patients treated by
>25% target dose of BB as compared to those treated with ≤
25% target dose (17.6% vs. 33.9%, p 0.017). This was not observed in
patients taking >25% AngA (30% vs. 26% p 0.55) or MRA
(29.5% vs. 26.5% p=0.64) compared to those treated by ≤ 25% target
dose of these medications. Kapkan-Myer (KM) analysis for survival
without VA according to each medication group dose, supported reduced VA
among patients receiving > median dose of BB (Figure 2).
Univariate parameters found to be significantly associated with incident
VA were: heart rate at admission (HR 1.02; 95% CI 1.00-1.04; p=0.02),
DM (HR 0.42; 95% CI 0.23-0.78; p=0.006), and BB >25%
target dose (HR 0.51; 95% CI 0.27-0.98; p=0.04). In Cox multivariable
model for VA including age, gender, DM, medication dosage
(>25% target dose), and heart rate, both BB dose
> median dose (HR 0.443, 95% CI 0.222-1.022; p=0.021) and
DM (HR 0.454, 96% CI 0.237-0.868; p=0.017) were significantly and
independently associated with lower incidence of VA; while increased
heart rate was significantly associated with VA (HR 1.03, 95% CI
1.009-1.049; p=0.004) (Table 3).