Already low drug dose antagonism of the renin-angiotensin aldosterone system decreases 1-year mortality and rehospitalization in old heart failure patients

Soborun, Nisha; Mûller, Martín; Abdurashidova, Tamila; Τζίμας, Γεώργιος; Schukraft, Sara; Lu, Henri; Vollenweider, Pierre; Garnier, Anne; Monney, Pierre; Hullin, Roger

doi:10.1016/j.biopha.2022.113615

Cited by 3 publications

(3 citation statements)

References 27 publications

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“… 29 The EVOLUTION‐HF furthermore suggests that many Western European, American, and Asian patients remain on the HF drug dose prescribed at discharge from HHF 25 ; however, even a low drug dose level has been shown to improve survival. 30 Altogether, as similar change of HF drug medication occurs across different world regions after discharge from HHF, and, moreover, the two cohorts were treated in tertiary hospitals and followed in urban catchment areas, there is good reason to assume that application of the guidelines‐directed medical therapy was respected in the follow‐up of the study participants.…”

Section: Discussionmentioning

confidence: 99%

European Society of Cardiology guidelines and 1 year outcomes of acute heart failure treatment in Central Asia and Europe

Abdurashidova,

Müller,

Schukraft

et al. 2023

ESC Heart Failure

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AimsOutcomes reported for patients with hospitalization for acute heart failure (AHF) treatment vary worldwide. Ethnicity‐associated characteristics may explain this observation. This observational study compares characteristics and 1‐year outcomes of Kyrgyz and Swiss AHF patients against the background of European Society of Cardiology guidelines‐based cardiovascular care established in both countries.Methods and resultsThe primary endpoint was 1 year all‐cause mortality (ACM); the secondary endpoint was 1 year ACM or HF‐related rehospitalization. A total of 538 Kyrgyz and 537 Swiss AHF patients were included. Kyrgyz patients were younger (64.0 vs. 83.0 years, P < 0.001); ischaemic or rheumatic heart disease and chronic obstructive pulmonary disease were more prevalent (always P < 0.001). In Swiss patients, smoking, dyslipidaemia, hypertension, and atrial flutter/fibrillation were more frequent (always P ≤ 0.035); moreover, left ventricular ejection fraction (LVEF) was higher (47% vs. 36%; P < 0.001), and >mild aortic stenosis was more prevalent (P < 0.001). Other valvular pathologies were more prevalent in Kyrgyz patients (P < 0.001). At discharge, more Swiss patients were on vasodilatory treatment (P < 0.006), while mineralocorticoid receptor antagonists (P = 0.001), beta‐blockers (P = 0.001), or loop diuretics (P < 0.001) were less often prescribed. In Kyrgyz patients, unadjusted odds for the primary and secondary endpoints were lower [odds ratio (OR) 0.68, 95% confidence interval (CI): 0.51–0.90, P = 0.008; OR 0.72, 95% CI: 0.56–0.91, P = 0.006, respectively]. After adjustment for age and LVEF, no difference remained (primary endpoint: OR 1.03, 95% CI: 0.71–1.49, P = 0.894; secondary endpoint: OR 0.82, 95% CI: 0.60–1.12, P = 0.206).ConclusionsOn the background of identical guidelines, age‐ and LVEF‐adjusted outcomes were not different between Central Asian and Western European AHF patients despite of large ethnical disparity.

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Section: Discussionmentioning

confidence: 99%

European Society of Cardiology guidelines and 1 year outcomes of acute heart failure treatment in Central Asia and Europe

Abdurashidova,

Müller,

Schukraft

et al. 2023

ESC Heart Failure

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“…Often, a low BP challenges the start of any HF drug and a more important decrease of BP after start with a low dose HF drug treatment question further uptitration for fear of incremental BP reduction. This may explain why in the real world only about one third of HFrEF patients with a systolic BP <110 mmHg receive ≥50% of guideline‐directed medical treatment target dose as shown in the QUALIFY registry 11 and this portion is even lower in the old and very old HF patient 12 …”

Section: Figurementioning

confidence: 99%

“…This may explain why in the real world only about one third of HFrEF patients with a systolic BP <110 mmHg receive ≥50% of guideline-directed medical treatment target dose as shown in the QUALIFY registry 11 and this portion is even lower in the old and very old HF patient. 12 However, Girerd et al 1 show that the risk for the combined endpoint is progressively attenuated with uptitration of vasodilatory drugs, beta-blockers, and mineralocorticoid receptor antagonists even in the low and very low BP strata. Despite this encouraging observation, the fear of symptomatic hypotension remains a concern in HFrEF patients with low BP.…”

mentioning

confidence: 99%

Advantage of uptitration of foundational heart failure drugs in heart failure with reduced ejection fraction and low blood pressure

Hullin

2024

European J of Heart Fail

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This article refers to 'Hypotension in heart failure is less harmful if associated with high or increasing doses of heart failure medication: Insights from the Swedish Heart Failure Registry' by N. Girerd et al., published in this issue on pages 359-369.In this issue of the Journal, Girerd et al. 1 provide evidence that optimized medication in patients with heart failure with reduced ejection fraction (HFrEF) and low blood pressure (BP) attenuates the risk of the combined incidence of cardiovascular death or heart failure (HF) hospitalization. In addition, this analysis in HFrEF patients in follow-up by the Swedish HF registry shows that a >10 mmHg systolic BP decrease due to HF drug dose increase is associated with a lower risk of the combined endpoint when compared to patients with such a BP decrease while on stable or decreasing HF drug dose treatment. These findings are important since they provide a sophisticated view on ambulatory chronic HF patients with low BP which are known for a higher incidence of all-cause mortality or heart transplantation when compared to patients with higher BP. 2 Benefit from uptitration of HF drugs has already been demonstrated across all strata of baseline systolic BP in randomized controlled trials testing all foundational HF drugs in HFrEF. [3][4][5][6][7][8] Evidence of favourable effects of HF drugs independent of the BP stratum is therefore not new even in HFrEF patients with lower BP. However, the present study extends randomized clinical trial results to real-world HFrEF patients in the low or very low BP stratum (90-99 mmHg, n = 2761; and <90 mmHg, n = 792, respectively). This confirms applicability of randomized trial results to daily practice and complements findings suggesting benefit from increase of HF drug dose in HFrEF patients with a systolic BP ≤100 mmHg after an acute HF episode 9 or in ambulatory chronic HFrEF patients with low BP and concomitant renal dysfunction. 10 However, a gap of knowledge remains since angiotensin-neprilysin or sodium-glucose cotransporter 2 inhibition were not investigated by Girerd et al. due to lack of data.

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Multidisciplinary diagnosis and treatment model based on a retrospective cohort study: Pulmonary function and prognosis quality of life in severe COPD

Liu¹,

Kang²

2024

THC

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BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease worsening airflow limitation. OBJECTIVE: To explore pulmonary function rehabilitation, life quality and prognosis in patients with severe COPD. METHODS: Between February 2018 and August 2021, 150 patients with severe COPD cured in our hospital were arbitrarily assigned into the control group (n= 75) and study group (n= 75). The control group received routine treatment and the research group received multidisciplinary diagnosis and treatment. The body mass index, airflow obstruction, dyspnea and exercise (BODE), pulmonary function, the number of acute attacks, 6-minute walking distance (6MWD), Borg score and life quality were compared. RESULTS: There was no remarkable difference in BODE score before treatment (P> 0.05). During the 2- and 6-month following treatment, the BODE score of the study group was lower (P< 0.05). In the study group, FEV1 percentage of the predicted value, forced expiratory volume in one second (PPO-FEV1) and the percentage of forced expiratory volume in one second/forced vital capacity (FEV1/FVC) in the first second were higher (P< 0.05). In the study group, there were fewer acute attacks (P< 0.05). After treatment, the 6MWD of the study group following 2- and 6-month treatment was higher (P< 0.05). The Borg scores of the study group at 2- and 6-months after treatment were lower (P< 0.05). There were no remarkable differences in the score of life quality before treatment (P> 0.05), however, the symptom score, activity score, influence score and total score of the study group were lower after the treatment (P< 0.05). CONCLUSION: The application of multidisciplinary diagnosis and treatment model can promote the rehabilitation of pulmonary function of patients with severe COPD, improve their prognosis, slow down the development of the disease and enhance their life quality.

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Already low drug dose antagonism of the renin-angiotensin aldosterone system decreases 1-year mortality and rehospitalization in old heart failure patients

Cited by 3 publications

References 27 publications

European Society of Cardiology guidelines and 1 year outcomes of acute heart failure treatment in Central Asia and Europe

European Society of Cardiology guidelines and 1 year outcomes of acute heart failure treatment in Central Asia and Europe

Advantage of uptitration of foundational heart failure drugs in heart failure with reduced ejection fraction and low blood pressure

Multidisciplinary diagnosis and treatment model based on a retrospective cohort study: Pulmonary function and prognosis quality of life in severe COPD

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