Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the CHECK-HF registry

Linssen, Gerard C.M.; Veenis, Jesse F.; Rocca, Hans‐Peter Brunner‐La; Pol, P.E.J. van; Engelen, Domien J; Tooren, Rob M. van; Koornstra-Wortel, Hetty J J; Hoes, Arno W.; Brugts, Jasper J.

doi:10.1007/s12471-020-01421-1

Cited by 13 publications

(17 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In 2020, the 2016 European guideline on acute and chronic heart failure was still not fully adopted into daily practice when looking at the number of prescribed heart failure medication. 28 Therefore, the observed improvement in awareness, diagnostic delay and severity will not be solely explained by the increase in scientific output. The implementation of the clinical pathway has contributed to faster implementation of scientific knowledge in CA in our expertise centre, resulting in the growing number of diagnoses, referrals, and reduction in the often very delayed time to treatment initiation in CA patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the cardiac amyloidosis clinical pathway implementation: a real-world experience

Brons

Muller

Rutten

et al. 2022

European Heart Journal Open

View full text Add to dashboard Cite

Aims To evaluate the implementation of the CA clinical pathway on awareness among referring cardiologists, diagnostic delay and severity of CA at diagnosis. Methods and results Patients with CA were retrospectively included in this study and divided in pre-implementation of the CA clinical pathway (2007-2018; T1) and post-implementation (2019-2020; T2). Patients’ and disease characteristics were extracted from electronic health records and compared. In total, 113 patients (mean age 67.8±8.5 years, 26% female) were diagnosed with CA (T1 (2007-2018): 56; T2 (2019-2020): 57). The number of CA diagnoses per year increased over time. Reasons for referral changed over time, with increased awareness for right ventricular hypertrophy (9% in T1 vs. 36% in T2) and unexplained heart failure with preserved ejection fraction (22% in T1 vs. 38% in T2). Comparing T1 with T2, diagnostic delay also improved (14 vs. 8 months, p < 0.01), NYHA class III (45% vs. 23%,p=0.03) and advanced CA stage (MAYO/Gillmore stage III/IV; 61% vs. 33%, p = <0.01) at time of diagnosis decreased. Conclusion After implementation of the CA clinical pathway the awareness among referring cardiologists was improved, diagnostic delay was decreased and patients had less severe CA at diagnosis. Further studies are warranted to assess the prognostic impact of CA clinical pathway implementation.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of the cardiac amyloidosis clinical pathway implementation: a real-world experience

Brons

Muller

Rutten

et al. 2022

European Heart Journal Open

View full text Add to dashboard Cite

show abstract

“…The quality of this medical treatment is excellent in the context of a clinical trial [ 13 ]. However, analysis of clinical registries and databases indicates that there is room for improvement [ 14 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics

Delgado-Jiménez

Segovia‐Cubero

Almenar‐Bonet

et al. 2022

JCM

View full text Add to dashboard Cite

Hyperkalaemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) as it limits the use of some prognostic-modifying drugs and has a negative impact on prognosis. The objective of the present study was to estimate the prevalence of hyperkalaemia in outpatients with HFrEF and its impact on achieving optimal medical treatment. For this purpose, a multicentre, prospective, and observational study was carried out on consecutive HFrEF patients who were monitored as outpatients in heart failure (HF) units and who, in the opinion of their doctor, received optimal medical treatment. A total of 565 HFrEF patients were included from 16 specialised HF units. The mean age was 66 ± 12 years, 78% were male, 45% had an ischemic cause, 39% had atrial fibrillation, 43% were diabetic, 42% had a glomerular filtration rate < 60 mL/min/1.7 m2, and the mean left ventricular ejection fraction was 31 ± 7%. Treatment at the study entry included: 76% on diuretics, 13% on ivabradine, 7% on digoxin, 18.9% on angiotensin-conversing enzyme inhibitors (ACEi), 11.3% on angiotensin receptors blockers (ARBs), 63.8% on angiotensin-neprilysin inhibitors (ARNi), 78.5% on mineralocorticoid receptor antagonists (MRAs), and 92.9% on beta-blockers. Potassium levels in the baseline analysis were: ≤5 mEq/L = 80.5%, 5.1–5.4 mEq/L = 13.8%, 5.5–5.9 mEq/L = 4.6%, and ≥6 mEq/L = 1.06%. Hyperkalaemia was the reason for not prescribing or reaching the target dose of an MRAs in 34.8% and 12.5% of patients, respectively. The impact of hyperkalaemia on not prescribing or dropping below the target dose in relation to ACEi, ARBs, and ARNi was significantly less. In conclusion, hyperkalaemia is a frequent problem in the management of patients with HFrEF and a limiting factor in the optimisation of medical treatment.

show abstract

“…Also, the that about 40% of patients treated with spironolactone in our study were not prescribed a guideline-recommended dose may have may have influenced the efficacy of spironolactone treatment. Although current guidelines recommend 25 mg spironolactone once daily with titration up to 50 mg once daily for patients with HFrEF based on landmark trials ( 17 , 30 ), a large number of patients are treated with spironolactone doses of less than 25 mg in real-world practice ( 19 , 33 ). The dose response relationship between spironolactone and survival has not yet been clearly identified.…”

Section: Discussionmentioning

confidence: 99%

The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort Study

Youn

Lee

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundRandomized clinical trials of spironolactone showed significant mortality reduction in patients with heart failure with reduced ejection fraction. However, its role in acute heart failure syndrome (AHFS) is largely unknown.AimTo investigate the prescription characteristics, efficacy and safety of spironolactone in real-world patients with AHFS.Methods5,136 AHFS patients who survived to hospital discharge using a nationwide prospective registry in Korea were analyzed. The primary efficacy outcome was 3-year all-cause mortality.ResultsSpironolactone was prescribed in 2,402 (46.8%) at discharge: <25 mg in 890 patients (37.1%), ≥25 mg, and <50 mg in 1,154 patients (48.0%), and ≥50 mg in 358 patients (14.9%). Patients treated with spironolactone had a lower proportion of chronic renal failure and renal replacement therapy during hospitalization and had lower serum creatinine level than those who did not. In overall patients, 3-year mortality was not different in both groups (35.9 vs. 34.5%, P = 0.279). The incidence of renal injury and hyperkalemia was 2.2% and 4.3%, respectively, at the first follow-up visit. The treatment effect of spironolactone on mortality was different across subpopulations according to LVEF. The use of spironolactone was associated with a significant reduction in 3-year morality in patients with LVEF ≤ 26% (33.8 vs. 44.3%, P < 0.001; adjusted HR 0.79, 95% CI 0.64–0.97, P = 0.023), but not in patients with LVEF > 26%.ConclusionsAlthough spironolactone was frequently used at lower doses in real-world practice, use of spironolactone significantly reduced 3-year mortality in patients with severely reduced LVEF with acceptable safety profile. However, our findings remain prone to various biases and further prospective randomized controlled studies are needed to confirm these findings.

show abstract

Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the CHECK-HF registry

Cited by 13 publications

References 33 publications

Evaluation of the cardiac amyloidosis clinical pathway implementation: a real-world experience

Evaluation of the cardiac amyloidosis clinical pathway implementation: a real-world experience

Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics

The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort Study

Contact Info

Product

Resources

About