Adherence and optimization of angiotensin converting enzyme inhibitor/angiotensin II receptors blockers and beta‐blockers in patients hospitalized for acute heart failure

Carubelli, Valentina; Lombardi, Carlo; Specchia, Claudia; Peveri, Giulia; Oriecuia, Chiara; Tomasoni, Daniela; Pasquale, Mattia Di; Garrafa, Emirena; Metra, Marco

doi:10.1002/ehf2.13223

Cited by 16 publications

(20 citation statements)

References 22 publications

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“…Pre‐existing renal dysfunction is a possible determinant of the direction of potassium levels oscillation during AHF treatment. In addition, hyperkalaemia is one of most common cause of no or low dose prescription of ACEi/ARBs and/or MRA, 18 , 19 drugs with well‐known beneficial effects on outcomes also in the acute setting as being demonstrated in several recent studies, 13 , 20 although, as stated previously, we did non observe a lower prescription of ACEi/ARBs or MRA in patients with hyperkalaemia.…”

Section: Discussionsupporting

confidence: 65%

“…Another aspect that should be taken into account is the link between serum potassium and treatment prescription dosing. In fact, the use of target doses of RAAs inhibitors has been associated with better outcomes after discharge, despite only a minority of patients is able to tolerate doses >50% of target 13 . In this context, hyperkalaemia represents one of the main reasons of not optimal dosing of these drugs with possible detrimental effects on patients' outcomes 14 …”

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of serum potassium in patients hospitalized for acute heart failure

et al. 2022

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AimWe investigated the prognostic significance of serum potassium abnormalities at discharge in patients hospitalized for acute heart failure (AHF). Methods and resultsIn a retrospective analysis, we included 926 patients hospitalized for AHF, stratified by serum potassium levels at discharge as hypokalaemia (<3.5 mEq/L), normokalaemia (3.5-5.0 mEq/L), and hyperkalaemia (>5.0 mEq/L). The primary endpoint was all-cause death at 1 year since hospital discharge. At discharge, 40 patients had hypokalaemia (4.3%), 840 normokalaemia (90.7%), and 46 hyperkalaemia (5.0%). Patients with hyperkalaemia at discharge were more frequently men, had more signs of congestion, and lower LVEF while patients with hypokalaemia were more likely to be women with HFpEF. Treatment with ACEi/ARBs and MRAs ≥50% of target dose at discharge was similar across groups. One year all-cause death occurred in 10% of the patients with hypokalaemia, 13.9% of those with normokalaemia, and 30.4% of those with hyperkalaemia (P = 0.006). After adjustment for covariates, including renal function, background treatment, and baseline potassium level, hyperkalaemia resulted an independent predictor of the primary endpoint (HR 1.96, 95% IC [1.01-3.82]; P = 0.048). Conclusions In patients with AHF, the presence of hyperkalaemia at discharge is an independent predictor of 1 year all-cause death.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Prognostic significance of serum potassium in patients hospitalized for acute heart failure

et al. 2022

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“…Neurohormonal antagonists, including angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists, and sodiumglucose co-transporter 2 (SGLT2) inhibitors, are the mainstay of HFrEF treatment, improving the clinical course of HF. 7,[12][13][14][15][16] Adherence to GDMT is associated with improved outcome. [17][18][19][20][21][22] Data from population-based studies reported a decline in HF-related hospitalizations and mortality over the last two decades.…”

Section: Evidence-based Therapy For Heart Failure With Reduced Ejecti...mentioning

confidence: 99%

Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care

et al. 2022

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Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality of life and a major burden for the healthcare system. The number of patients that progress to an advanced stage of HF is growing. Only a limited proportion of these patients can undergo heart transplantation or mechanical circulatory support. The purpose of this review is to summarize medical management of patients with advanced HF. First, evidence‐based oral treatment must be implemented although it is often not tolerated. New therapeutic options may soon become possible for these patients. The second goal is to lessen the symptomatic burden through both decongestion and haemodynamic improvement. Some new treatments acting on cardiac function may fulfil both these needs. Inotropic agents acting through an increase in intracellular calcium have often increased risk of death. However, in the recent Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial, omecamtiv mecarbil was safe and effective in the reduction of the primary outcome of cardiovascular death or HF event compared with placebo (hazard ratio, 0.92; 95% confidence interval, 0.86–0.99; P = 0.03) and its effects were larger in those patients with more severe left ventricular dysfunction. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit, whereas patients without severe HF did not (P = 0.005 for interaction). Lastly, clinicians should take care of the end of life with an appropriate multidisciplinary approach. Medical treatment of advanced HF therefore remains a major challenge and a wide open area for further research.

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“…Neurohormonal modulators include the angiotensin receptor‐neprilysin inhibitor (ARNI), sacubitril/valsartan (possibly as first‐line therapy), or an angiotensin‐converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) if ACEi is not tolerated, a beta‐blocker and a mineralocorticoid receptor antagonist (MRA) 1 . Despite the widespread knowledge about the importance of initiating and titrating GDMT, 113 only a minority of eligible patients receive all the medications proven to be effective in preventing death and hospitalizations 114 . Moreover, a significant proportion of patients never receives target doses used in the landmark trials 111,115,116 .…”

Section: Treatment Of Heart Failure With Reduced Ejection Fractionmentioning

confidence: 99%

A year in heart failure: an update of recent findings

et al. 2021

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Major changes have occurred in these last years in heart failure (HF) management. Landmark trials and the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of HF have established four classes of drugs for treatment of HF with reduced ejection fraction: angiotensin‐converting enzyme inhibitors or an angiotensin receptor‐neprilysin inhibitor, beta‐blockers, mineralocorticoid receptor antagonists, and sodium‐glucose co‐transporter 2 inhibitors, namely, dapagliflozin or empagliflozin. These drugs consistently showed benefits on mortality, HF hospitalizations, and quality of life. Correction of iron deficiency is indicated to improve symptoms and reduce HF hospitalizations. AFFIRM‐AHF showed 26% reduction in total HF hospitalizations with ferric carboxymaltose vs. placebo in patients hospitalized for acute HF (P = 0.013). The guanylate cyclase activator vericiguat and the myosin activator omecamtiv mecarbil improved outcomes in randomized placebo‐controlled trials, and vericiguat is now approved for clinical practice. Treatment of HF with preserved ejection fraction (HFpEF) was a major unmet clinical need until this year when the results of EMPEROR‐Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic HFpEF) were issued. Compared with placebo, empagliflozin reduced by 21% (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P < 0.001), the primary outcome of cardiovascular death or HF hospitalization. Advances in the treatment of specific phenotypes of HF, including atrial fibrillation, valvular heart disease, cardiomyopathies, cardiac amyloidosis, and cancer‐related HF, also occurred. Coronavirus disease 2019 (COVID‐19) pandemic still plays a major role in HF epidemiology and management. All these aspects are highlighted in this review.

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Adherence and optimization of angiotensin converting enzyme inhibitor/angiotensin II receptors blockers and beta‐blockers in patients hospitalized for acute heart failure

Cited by 16 publications

References 22 publications

Prognostic significance of serum potassium in patients hospitalized for acute heart failure

Prognostic significance of serum potassium in patients hospitalized for acute heart failure

Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care

A year in heart failure: an update of recent findings

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