Early and short‐term intensive management after discharge for patients hospitalized with acute heart failure: a randomized study (<scp>ECAD‐HF</scp>)

Logeart, Damien; Berthelot, E.; Bihry, Nicolas; Eschalier, Romain; Salvat, Muriel; Garçon, Philippe; Eicher, Jean‐Christophe; Cohen, Ariel; Tartière, Jean-Michel; Samadi, Alireza; Donal, Erwan; Groote, Pascal de; Mewton, Nathan; Mansencal, Nicolas; Raphael, Pierre; Ghanem, Nachwan; Seronde, Marie‐France; Chavelas, Christophe; Rosamel, Yann; Beauvais, Florence; Kévorkian, Jean-Philippe; Vicaut, Éric; Isnard, R.

doi:10.1002/ejhf.2357

Cited by 18 publications

(11 citation statements)

References 24 publications

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“…Indeed, intensive support after decompensated HF hospitalization has recently been shown to achieve only modest improvements in GDMT dosing, which did not translate into improved hard outcomes. 24 Whilst we did not see increased risk of re‐hospitalization with HF in people with reduced ACEi/ARB or beta‐blocker dose, the observed 1 year risk exceeded 10%, serving as a reminder of the scope for escalation of GDMT to improve this, especially in the ARNI and SGLT2 inhibitor era. 25 The absence of increased risk of re‐hospitalization with HF after ACEi/ARB dose reduction, in the context of an increased mortality rate, is also notable.…”

Section: Discussionmentioning

confidence: 73%

“…However, it seems likely that a significant proportion of people would be candidates for re‐escalation of ACEi/ARB soon after discharge, although the inertia we observed during hospitalization would suggest that such optimization is probably uncommon. Indeed, intensive support after decompensated HF hospitalization has recently been shown to achieve only modest improvements in GDMT dosing, which did not translate into improved hard outcomes 24 . Whilst we did not see increased risk of re‐hospitalization with HF in people with reduced ACEi/ARB or beta‐blocker dose, the observed 1 year risk exceeded 10%, serving as a reminder of the scope for escalation of GDMT to improve this, especially in the ARNI and SGLT2 inhibitor era 25 .…”

Section: Discussionmentioning

confidence: 99%

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Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes

et al. 2022

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Aims Optimal management of heart failure with reduced ejection fraction (HFrEF) includes titration of guideline-directed medical therapy (GDMT) to the highest tolerated dose within the licensed range. During hospitalization, GDMT doses are often significantly altered, although it is unknown whether the cause of hospitalization influences this. Methods and resultsWe recruited 711 people with stable HFrEF from specialist heart failure clinics and prospectively assessed events occurring during first unplanned hospitalization. Dose changes of ACE inhibitors or angiotensin receptor blockers (ACEi/ARB), beta-blockers, mineralocorticoid receptor antagonists, and loop diuretics were recorded during 414 hospitalizations, categorized as due to decompensated heart failure, other cardiovascular causes, infection, or other non-cardiovascular causes. Most hospitalizations resulted in no change to GDMT. ACEi/ARB dose was reduced in 21% of hospitalizations and was more common during non-cardiovascular hospitalization (25.4% vs. 13.9%; P = 0.005). ACEi/ARB dose reduction was associated with older age and lower left ventricular ejection fraction at study recruitment, and poorer renal function, lower systolic blood pressure, higher serum potassium, and less frequent care from a cardiologist during admission. People experiencing ACEi/ARB reduction had worse age-adjusted survival after discharge, without differences in heart failure re-hospitalization. De-escalation of beta-blockers occurred in 8% of hospitalizations, most often due to other non-cardiovascular causes; this was not associated with post-discharge survival or re-hospitalization with heart failure. Conclusions De-escalation of HFrEF GDMT is more common during non-cardiovascular hospitalization and for ACEi/ARB is associated with reduced survival. Post-discharge care plans should include robust plans to consider re-escalation of GDMT in these cases.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes

et al. 2022

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“…In the first, Jaarsma et al 16 found no effect of early, more intense follow-up in patients after an AHF admission on readmissions and death. In the second, Logeart et al 17 equally found no effect of early follow-up on death or readmissions (hazard ratio 0.97, 95% CI 0.74-1.26), or on 6-or 12-month mortality, or on unplanned HF rehospitalization. They also noted that the groups did not differ according to age, previous HF, or EF.…”

Section: More or Less Follow-up?mentioning

confidence: 97%

Targeting the ‘vulnerable’ period – first 3–6 months after an acute heart failure admission – the light gets brighter

Cotter

Davison

Cohen‐Solal

et al. 2022

European J of Heart Fail

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Research into acute heart failure (AHF) therapy at and after discharge has progressed significantly in recent years. 1 Despite this progress, patients' outcomes and quality of life remain dismal, leaving much room for improvement. [2][3][4] Acute heart failure is a severe disease with dire prognosis during the first 3-6 months after dischargeAlthough any manuscript on AHF starts with this comment in both introduction and discussion, the severity of the disease does not seem to be fully appreciated. Recent studies have shown that, despite best therapy, the mortality of AHF remains at around 10% over the first 6 months; rates of readmission and death, denoting disease progression, remain stubbornly >25%. Such a prognosis can be compared only with some aggressive cancers 5 and should have prompted both physicians and patients to implement early and aggressive disease management plans including frequent visits, close surveillance, and immediate implementation of full guideline-directed medical therapies (GDMT). Alas, this is not the case.In a recent European study, 6 only 72% of patients had a post-discharge outpatient visit within 3 months (after a mean of 45 ± 28 days), and many patients were not aware of their diagnosis or its severity. Therefore, if we are to implement the advances that are made possible by recent studies, the first priority should be to raise awareness of physicians and patients of the severity of AHF so that both will be willing to engage in closer follow-up and rapid GDMT implementation, and to accept that this strategy may have some short-term adverse effects (as they do when

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“…Acute HF remains a life‐threatening condition, burdened by high mortality 17,18 . A total of 5951 participants in the ESC HF Long‐Term Registry hospitalized for acute HF were stratified according to their ejection fraction (EF) into those with reduced (HFrEF), mildly reduced (HFmrEF) or preserved EF (HFpEF).…”

Section: Acute Heart Failurementioning

confidence: 99%

February 2022 at a glance: focus on pathophysiology and acute heart failure

Tomasoni

Adamo

Metra

2022

European J of Heart Fail

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This issue includes a two-part position statement from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) about the pathophysiology of Takotsubo syndrome. It provides an overview on the role of catecholamines and sympathetic nervous system and a throughout discussion on vascular pathophysiology and gender differences. 1,2 Physical exercise and nutritionExercise capacity is impaired in patients with heart failure (HF) with a major impact on their poorer quality of life and frequent hospitalizations. [3][4][5] Nijholt et al. 6 reviewed the most recent findings in the field, focusing on newly discovered pathways associated with muscular growth, mechanisms of exercise intolerance and potential therapeutic options.The role of nutritional status in HF patients is well-established. 7,8 Malnutrition refers also to specific micronutrient deficiencies (i.e. selenium). The levels of selenium were measured in a cohort of 5973 Dutch subjects. Higher levels of selenium were independently associated with a lower risk of death and new-onset HF. A significant interaction was found between smoking status and the impact of selenium levels on clinical events. 9

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Early and short‐term intensive management after discharge for patients hospitalized with acute heart failure: a randomized study (ECAD‐HF)

Cited by 18 publications

References 24 publications

Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes

Reduction of heart failure guideline‐directed medication during hospitalization: prevalence, risk factors, and outcomes

Targeting the ‘vulnerable’ period – first 3–6 months after an acute heart failure admission – the light gets brighter

February 2022 at a glance: focus on pathophysiology and acute heart failure

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