Table 3.
Factor | Stay low | Up‐titrate | Down‐titrate | Stay high | P value |
---|---|---|---|---|---|
N | 439 | 82 | 34 | 236 | |
Demographics | |||||
Age (years), mean (SD) | 61.9 (13.2) | 61.1 (12.9) | 64.0 (10.6) | 61.1 (11.9) | 0.6 |
Women | 70 (15.9%) | 12 (14.6%) | 8 (23.5%) | 37 (15.7%) | 0.67 |
Enrolled in SG (vs. NZ) | 328 (74.7%) | 41 (50.0%) | 20 (58.8%) | 106 (44.9%) | <0.001 |
Enrolled as inpatient | 260 (59.2%) | 50 (61.0%) | 22 (64.7%) | 139 (58.9%) | 0.92 |
History of prior HF hospitalization | 273 (62.2%) | 32 (39.0%) | 18 (52.9%) | 121 (51.3%) | <0.001 |
Clinical exam/signs and symptoms | |||||
NYHA Class III/IV (vs. I/II) | 99 (22.8%) | 14 (17.1%) | 10 (29.4%) | 54 (23.2%) | 0.5 |
BMI (kg/m2), mean (SD) | 26.1 (5.1) | 27.2 (5.5) | 26.0 (4.9) | 28.9 (6.6) | <0.001 |
BSA (m2), mean (SD) | 1.79 (0.22) | 1.89 (0.22) | 1.82 (0.24) | 1.94 (0.26) | <0.001 |
Systolic BP (mmHg), mean (SD) | 116.2 (18.1) | 124.0 (22.4) | 123.8 (22.6) | 123.7 (21.5) | <0.001 |
Diastolic BP (mmHg), mean (SD) | 70.1 (11.5) | 75.4 (14.6) | 72.3 (12.4) | 74.6 (14.3) | <0.001 |
Heart rate (b.p.m.), mean (SD) | 77.7 (13.5) | 73.6 (14.6) | 76.4 (16.7) | 74.4 (13.7) | 0.007 |
LVEF (%), median (IQR) | 25 (20, 30) | 25 (23, 31) | 30 (25, 34) | 28 (22, 34) | <0.001 |
Ischaemic aetiology | 277 (63.1%) | 35 (42.7%) | 21 (61.8%) | 118 (50.0%) | <0.001 |
Shortness of breath on exertion | 281 (64.2%) | 51 (62.2%) | 27 (79.4%) | 165 (69.9%) | 0.14 |
Shortness of breath at rest | 62 (14.2%) | 4 (4.9%) | 4 (11.8%) | 28 (11.9%) | 0.13 |
Reduction in exercise tolerance | 271 (61.7%) | 52 (63.4%) | 25 (73.5%) | 165 (69.9%) | 0.13 |
Orthopnoea | 107 (24.4%) | 17 (20.7%) | 10 (29.4%) | 56 (23.7%) | 0.78 |
Paroxysmal nocturnal dyspnoea | 72 (16.4%) | 14 (17.1%) | 10 (29.4%) | 33 (14.0%) | 0.16 |
Peripheral oedema | 136 (31.2%) | 24 (29.3%) | 14 (41.2%) | 81 (34.5%) | 0.51 |
Laboratory values | |||||
NT‐proBNP (ng/L), median (IQR) | 2314 (1223, 4507) | 1745 (980, 4689) | 3310 (1608, 7295) | 1651 (851, 3946) | 0.002 |
Potassium (mmol/L), median (IQR) | 4.1 (3.7, 4.5) | 4.0 (3.8, 4.3) | 4.1 (3.8, 4.5) | 4.1 (3.8, 4.5) | 0.48 |
eGFR (mL/min/1.73 m2), median (IQR) | 59.2 (47.0, 76.8) | 67.4 (54.1, 83.4) | 59.3 (40.8, 75.2) | 58.2 (46.9, 72.7) | 0.067 |
Medical history | |||||
Hypertension | 239 (55.6%) | 42 (51.9%) | 28 (82.4%) | 168 (72.1%) | <0.001 |
Diabetes | 202 (46.2%) | 30 (36.6%) | 13 (38.2%) | 109 (46.2%) | 0.34 |
Atrial fibrillation | 131 (29.8%) | 24 (29.3%) | 12 (35.3%) | 78 (33.1%) | 0.77 |
Anaemia | 142 (37.2%) | 24 (30.8%) | 14 (43.8%) | 56 (25.9%) | 0.022 |
Charlson comorbidity index, mean (SD) | 2.3 (1.3) | 2.1 (1.4) | 2.6 (1.7) | 2.5 (1.6) | 0.078 |
Medications at baseline | |||||
Beta‐blockers at baseline | 387 (88.6%) | 74 (90.2%) | 32 (94.1%) | 213 (91.0%) | 0.61 |
Beta‐blocker dose (%GRD) at baseline, median (IQR) | 25 (13, 50) | 25 (13, 50) | 50 (25, 63) | 50 (25, 63) | <0.001 |
MRA at baseline | 239 (54.4%) | 39 (47.6%) | 21 (61.8%) | 123 (52.1%) | 0.49 |
Loop diuretic at baseline | 403 (91.8%) | 74 (90.2%) | 34 (100.0%) | 222 (94.1%) | 0.21 |
Statin at baseline | 329 (74.9%) | 55 (67.1%) | 25 (73.5%) | 175 (74.2%) | 0.53 |
Outcomes | |||||
Composite outcome at 1 year | 131 (29.8%) | 16 (19.5%) | 15 (44.1%) | 66 (28.0%) | 0.054 |
%GRD, per cent guideline‐recommended dose; BMI, body mass index; BP, blood pressure; BSA, body surface area; eGFR, estimated glomerular filtration rate; HF, heart failure; IQR, interquartile range; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid receptor antagonist; NT‐proBNP, N‐terminal pro‐beta‐type natriuretic peptide; NYHA, New York Heart Association; NZ, New Zealand; RASi, renin–angiotensin system inhibitor; SD, standard deviation; SG, Singapore.