BackgroundKidney dysfunction (KD) is a main limiting factor of applying guideline‐directed medical therapy (GDMT) and reaching the recommended target doses (TD) in heart failure (HF) with reduced ejection fraction (HFrEF).HypothesisWe aimed to assess the success of optimization, long‐term applicability, and adherence of neurohormonal antagonist triple therapy (TT:RASi [ACEi/ARB/ARNI] + βB + MRA) according to the KD after a HF hospitalization and to investigate its impact on prognosis.MethodsThe data of 247 real‐world, consecutive patients were analyzed who were hospitalized in 2019−2021 for HFrEF and then were followed‐up for 1 year. The application and the ratio of reached TD of TT at hospital discharge and at 1 year were assessed comparing KD categories (eGFR: ≥90, 60−89, 45−59, 30−44, <30 mL/min/1.73 m2). Moreover, 1‐year all‐cause mortality and rehospitalization rates in KD subgroups were investigated.ResultsMajority of the patients received TT at hospital discharge (77%) and at 1 year (73%). More severe KD led to a lower application ratio (p < .05) of TT (92%, 88%, 80%, 73%, 31%) at discharge and at 1 year (81%, 76%, 76%, 68%, 40%). Patients with more severe KD were less likely (p < .05) to receive TD of MRA (81%, 68%, 78%, 61%, 52%) at discharge and a RASi (53%, 49%, 45%, 21%, 27%) at 1 year.One‐year all‐cause mortality (14%, 15%, 16%, 33%, 48%, p < .001), the ratio of all‐cause rehospitalizations (30%, 35%, 40%, 43%, 52%, p = .028), and rehospitalizations for HF (8%, 13%, 18%, 20%, 38%, p = .001) were significantly higher in more severe KD categories.ConclusionsKD unfavorably affects the application of TT in HFrEF, however poorer mortality and rehospitalization rates among them highlight the role of the conscious implementation and up‐titration of GDMT.

中文翻译：

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肾功能对射血分数降低心力衰竭指南指导药物治疗实施和预后的影响

背景肾功能障碍（KD）是射血分数降低的心力衰竭（HF）应用指南指导药物治疗（GDMT）和达到推荐目标剂量（TD）的主要限制因素。假设我们旨在评估射血分数降低的心力衰竭（HF）的成功率。根据心力衰竭住院后的KD，优化神经激素拮抗剂三联疗法（TT：RASi [ACEi/ARB/ARNI] + βB + MRA）的优化、长期适用性和依从性，并探讨其对预后的影响。方法247例患者的数据对 2019 年至 2021 年因 HFrEF 住院的真实世界连续患者进行了分析，然后随访了 1 年。比较 KD 类别（eGFR：≥90、60−89、45−59、30−44、<30 mL/min/1.73 m）评估出院时和 1 年时 TT 的应用和达到的 TD 比率2）。此外，还调查了 KD 亚组的 1 年全因死亡率和再住院率。结果大多数患者在出院时 (77%) 和 1 年时 (73%) 接受了 TT。更严重的 KD 导致施用率更低（p出院时和 1 年时 (81%、76%、76%、68%、40%) 的 TT (92%、88%、80%、73%、31%) < .05)。患有更严重 KD 的患者的可能性较小（p< .05) 在出院时接受 TD MRA (81%、68%、78%、61%、52%) 并在 1 年时接受 RASi (53%、49%、45%、21%、27%)。一年全因死亡率（14%、15%、16%、33%、48%、p< .001)，全因再住院率 (30%, 35%, 40%, 43%, 52%,p= .028），以及心力衰竭再住院（8%、13%、18%、20%、38%、p= .001) 在较严重的 KD 类别中显着较高。结论 KD 对 TT 在 HFrEF 中的应用产生不利影响，但其中较差的死亡率和再住院率凸显了有意识实施和上调 GDMT 的作用。