Background: Knowledge on the impact of multimorbidity on prescription rates (PR) of guideline-recommended drugs in patients hospitalized with acute heart failure (AHF) is limited. We studied PR of renin angiotensin system inhibitors (RASi), betablockers (BB), and mineralocorticoid receptor antagonists (MRA) by comorbidity burden (CB) and determined mortality risk.
 

Methods: 1000 patients hospitalized with AHF (75±11 years, 40% female, 18% de novo, ejection fraction [LVEF] 47±17%, LVEF >50%: 53%) were consecutively (ie, 24/7) enrolled in a prospective cohort study. On admission, at discharge and at 6-month follow-up (6MFUP), the proportion of patients taking each drug class was determined in subgroups by CB (number [N] present of: hypertension, chronic kidney disease, diabetes, anemia, chronic lung disease, psychiatric disorder, malignancy, atrial fibrillation, coronary heart disease, peripheral artery or cerebrovascular disease, hypercholesterolemia).

Results: Mean N of comorbidities was 5.4±1.7. Patients with higher CB were older and more often female (both p_trend<0.001), while LVEF did not differ across CB groups. Most patients had 3-4 or 5-6 comorbidities (28% and 42%, respectively). Regardless of CB severity, PR of all drug classes increased from admission to discharge (Figure A, B). Regardless of CB, no major alteration of PR in BB, MRA, and RASi occurred up to 6MFUP (Figure C). 12-month mortality was 12% in CB 0-2, 22% in CB 3-4, 23% in CB 5-6, and 30% in CB 7+ (age-adjusted p_trend =0.001). Age was inversely associated with PR of RASi and MRA, but unrelated to BB use.

Conclusions: Regardless of CB severity, higher PR of BB, RASi, and MRA were achieved in hospital after admission with AHF. Post discharge, further improvement or maintenance of PR seemed impeded throughout the multimorbidity spectrum. Age, but also CB severity correlated with 12-month mortality risk.