Guideline‐Directed Medical Therapy for Patients With Heart Failure With Midrange Ejection Fraction: A Patient‐Pooled Analysis From the KorHF and KorAHF Registries

Background Although current guidelines now define heart failure with midrange ejection fraction (HFmrEF) as HF with a left ventricular EF of 40% to 49%, there are limited data on response to guideline‐directed medical therapy in patients with HFmrEF. The current study aimed to evaluate the association between β‐blocker, renin‐angiotensin system blocker (RASB), or aldosterone antagonist (AA) treatment with clinical outcome in patients with HFmrEF. Methods and Results We performed a patient‐level pooled analysis on 1144 patients with HFmrEF who were hospitalized for acute HF from the KorHF (Korean Heart Failure) and KorAHF (Korean Acute Heart Failure) registries. The study population was divided between use of β‐blocker, RASB, or AA to evaluate the guideline‐directed medical therapy in patients with HFmrEF. Sensitivity analyses, including propensity score matching and inverse‐probability‐weighted methods, were performed. The use of β‐blocker in the discharge group showed significantly lower rates of all‐cause mortality compared with those who did not use a β‐blocker (β‐blocker versus no β‐blocker, 30.7% versus 38.2%; hazard ratio, 0.758; 95% confidence interval, 0.615–0.934; P=0.009). Similarly, the RASB use in the discharge group was associated with the lower risk of mortality compared with no use of RASB (RASB versus no RASB, 31.9% versus 38.1%; hazard ratio, 0.76; 95% confidence interval, 0.618–0.946; P=0.013). However, there was no significant difference in all‐cause mortality between AA and no AA in the discharge group (AA versus no AA, 34.2% versus 34.0%; hazard ratio, 1.063; 95% confidence interval, 0.858–1.317; P=0.578). Multiple sensitivity analyses showed similar trends. Conclusions For treatment of acute HFmrEF after hospitalization, β‐blocker and RASB therapies on discharge were associated with reduced risk of all‐cause mortality. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01389843.