Guideline-Directed Medical Therapy in Newly Diagnosed Heart Failure With Reduced Ejection Fraction in the Community

Dunlay, Shannon M.; Killian, Jill M.; Roger, Véronique L.; Schulte, Phillip J.; Blecker, Saul; Savitz, Samuel T.; Redfield, Margaret M.

doi:10.1016/j.cardfail.2022.07.047

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…According to the results of recently published data and our analysis, HFOC greatly impacts the implementation and continuous optimisation of novel GDMT [38,39]. A recently published cohort study by Dunlay et al revealed that care at an HF clinic is independently associated with the initiation of new first-line HFrEF drugs (referring to all conventional neurohormonal antagonist therapies) among de novo HFrEF patients, leading to a 1.54-2.49-fold increase in their implementation [39]. In our patient cohort, HFOC resulted in a significantly higher application rate of triple therapy at 1 year, and the number of patients at target doses of triple therapy also exceeded that in the non-HFOC group.…”

Section: Impact Of Heart Failure Outpatient Care On the Application O...mentioning

confidence: 86%

“…Despite this, it must be highlighted that these studies referred to stable patients already receiving GDMT and showing no signs of worsening heart failure. Moreover, the former were published before the results of the latest RCTs which have reformed the complex pharmacotherapy of HFrEF, and it is a well-known fact that HF outpatient care has a huge impact on the implementation and long-term application of novel GDMT [38,39]. Based on the disease's progressive nature [53], the regular revision of drug and device options and the need for advanced HF therapies is essential.…”

Section: Heart Failure Outpatient Care and The Prognosis Of Hfrefmentioning

confidence: 99%

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The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction

Muk,

Bánfi-Bacsárdi,

Vámos

et al. 2024

Diagnostics

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(1) Background: Besides the use of guideline-directed medical therapy (GDMT), multidisciplinary heart failure (HF) outpatient care (HFOC) is of strategic importance in HFrEF. (2) Methods: Data from 257 hospitalised HFrEF patients between 2019 and 2021 were retrospectively analysed. Application and target doses of GDMT were compared between HFOC and non-HFOC patients at discharge and at 1 year. 1-year all-cause mortality (ACM) and rehospitalisation (ACH) rates were compared using the Cox proportional hazard model. The effect of HFOC on GDMT and on prognosis after propensity score matching (PSM) of 168 patients and the independent predictors of 1-year ACM and ACH were also evaluated. (3) Results: At 1 year, the application of RASi, MRA and triple therapy (TT: RASi + βB + MRA) was higher (p < 0.05) in the HFOC group, as was the proportion of target doses of ARNI, βB, MRA and TT. After PSM, the composite of 1-year ACM or ACH was more favourable with HFOC (propensity-adjusted HR = 0.625, 95% CI = 0.401–0.974, p = 0.038). Independent predictors of 1-year ACM were age, systolic blood pressure, application of TT and HFOC, while 1-year ACH was influenced by the application of TT. (4) Conclusions: HFOC may positively impact GDMT use and prognosis in HFrEF even within the first year of its initiation.

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Section: Impact Of Heart Failure Outpatient Care On the Application O...mentioning

confidence: 86%

Section: Heart Failure Outpatient Care and The Prognosis Of Hfrefmentioning

confidence: 99%

The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction

Muk,

Bánfi-Bacsárdi,

Vámos

et al. 2024

Diagnostics

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“…Regarding follow-up structure, most participants schedule visits once a year, more often for patients with HFrEF, which might be linked to the higher number of therapeutical options available in this HF phenotype, the need of GDMT up-titration and the changing clinical profile over time which might trigger dose modification ( 19 , 20 ). Nurse-led HF clinics, currently mainly available in a secondary/tertiary care, are considered by most as an optimal setting for following HF patients and an excellent environment for up-titrating medications ( 21 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

The management of heart failure in Sweden—the physician’s perspective: a survey

Ferrannini,

Biber,

Abdi

et al. 2024

Front. Cardiovasc. Med.

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AimsTo assess the barriers to guideline-directed medical therapy (GDMT) use in heart failure (HF), diagnostic workup and general knowledge about HF among physicians in Sweden.MethodsA survey about the management of HF was sent to 828 Swedish physicians including general practitioners (GPs) and specialists during 2021–2022. Answers were reported as percentages and comparisons were made by specialty (GPs vs. specialists).ResultsOne hundred sixty-eight physicians participated in the survey (40% females, median age 43 years; 41% GPs and 59% specialists). Electrocardiography and New York Heart Association class evaluations are mostly performed once a year by GPs (46%) and at every outpatient visit by specialists (40%). Echocardiography is mostly requested if there is clinical deterioration (60%). One-third of participants screen for iron deficiency only if there is anemia. Major obstacles to implementation of different drug classes in HF with reduced ejection fraction are related to side effects, with no significant differences between specialties. Device implantation is deemed appropriate regardless of aetiology (69%) and patient age (86%). Specialists answered correctly to knowledge questions more often than GPs. Eighty-six percent of participants think that GDMT should be implemented as much as possible. Most participants (57%) believe that regular patient assessment in nurse-led HF clinics improve adherence to GDMT.ConclusionObstacles to GDMT implementation according to physicians in Sweden mainly relate to potential side effects, lack of specialist knowledge and organizational aspects. Further efforts should be placed in educational activities and structuring of nurse-led clinics.

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“…In clinical practice, a gap remains in implementing recommendations for optimizing GDMT for heart failure with reduced ejection fraction (HFrEF), defined as HF with an ejection fraction ≤40% [ 1 , 2 ]. This is due to multiple factors such as a variable patient profile, co-morbidities, difficulty of timely patient follow-up, and the increasing complexity of the treatment regimen [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

A Case-Based Implementation of Heart Failure Therapies, A Consensus Pathway by The Saudi Heart Failure Working Group

Bakhsh,

Jelaidan,

Chaudhary

et al. 2024

Journal of the Saudi Heart Association

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The implementation of guideline-directed medical therapy (GDMT) in heart failure (HF) has many challenges in real-world clinical practice. The consensus document is written considering the variability of the clinical presentation of HF patients. HF medical therapies need frequent dose adjustment during hospital admission or when patients develop electrolyte imbalance, acute kidney injury, and other acute illnesses. The paper describes clinical scenarios and graphs that will aid the managing physicians in decision-making for HF therapy optimization.

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Guideline-Directed Medical Therapy in Newly Diagnosed Heart Failure With Reduced Ejection Fraction in the Community

Cited by 8 publications

References 25 publications

The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction

The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction

The management of heart failure in Sweden—the physician’s perspective: a survey

A Case-Based Implementation of Heart Failure Therapies, A Consensus Pathway by The Saudi Heart Failure Working Group

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