Intensity of Guideline-Directed Medical Therapy for Coronary Heart Disease and Ischemic Heart Failure Outcomes

Crosier, Rebecca; Austin, Peter C.; Ko, Dennis T.; Lawler, Patrick R.; Stukel, Thérèse A.; Farkouh, Michael E.; Wang, Xuesong; Spertus, John A.; Ross, Heather J.; Lee, Douglas S.

doi:10.1016/j.amjmed.2020.10.017

Cited by 4 publications

(3 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A number of reasons have been deemed responsible for this slow implementation: (1) biomedical patient-related reasons, which have been reported as the most common and include renal insufficiency, hypotension, and hyperkalemia for ACE-Is/ ARBs and MRAs, as well as bradycardia, hypotension, and respiratory disease for BBs. [25][26][27] The percentage of such comorbid conditions seems to be higher in real world compared with randomized clinical trials, especially in the presence of concurrent AF, 28 (2) physician-related factors including lack of awareness of treatment goals, fear of adverse effects, and reluctance to use newly recommended drugs or to combine multiple therapies, and (3) nonmedical factors, such as the medication cost and incomplete access to health care systems which restricts dose adjustments in an outpatient setting. [29][30][31][32] In our analysis, only worsening renal function was shown to be strong predictor of optimally targeted GDMT inconsistency.…”

Section: Discussionmentioning

confidence: 99%

Prescription Rates and Prognostic Implications of Optimally Targeted Guideline-Directed Medical Treatment in Heart Failure and Atrial Fibrillation: Insights From The MISOAC-AF Trial

Moysidis

Κάρτας

Samaras

et al. 2023

Journal of Cardiovascular Pharmacology

View full text Add to dashboard Cite

Heart failure (HF) and atrial fibrillation (AF) commonly coexist in real-life clinical practice. Among patients with HF with reduced ejection fraction (HFrEF) or HF with mildly reduced ejection fraction (HFmrEF), guidelines call for evidencebased target doses of renin-angiotensin-aldosterone system inhibitors and beta-blockers. However, target doses of guidelinedirected medical treatment (GDMT) are often underused in realworld conditions, including HF-AF comorbidity. This retrospective cohort study of a randomized trial (Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with nonvalvular AF) included hospitalized patients with AF and HFrEF or HFmrEF. Optimally targeted GDMT was defined as intake of evidence-based target doses of renin-angiotensin-aldosterone system and beta-blockers at 3 months after discharge. Rates of optimally targeted GDMT achievement across the baseline estimated glomerular filtration rate (eGFR) were assessed. Independent predictors of nontargeted GDMT and its association with all-cause mortality and the composite of cardiovascular death or HF hospitalization were assessed by regression analyses. In total, 374 patients with AF and HFrEF or HFmrEF were studied. At 3 months after discharge, 30.7% received target doses of GDMT medications. The rate of optimally targeted GDMT was reduced by 11% for every 10 mg/min/1.73 m 2 decrease in baseline eGFR [adjusted b = 0.99; 95% confidence interval (CI), 0.98-0.99] levels. After a median 31-month follow-up period, 37.8% patients in the optimally targeted GDMT group died, as compared with 67.8% (adjusted hazard ratio: 1.49; 95% CI, 1.05-2.13) in the nontargeted GDMT group. The risk of cardiovascular death or HF hospitalization was also higher in these patients (adjusted hazard ratio: 1.60; 95% CI, 1.17-2.20). Target doses of all HF drugs were reached in roughly one-third of patients with AF and HFrEF or HFmrEF 3 months after hospital discharge. Nontargeted GDMT was more frequent across lower eGFR levels and was associated with worse outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Prescription Rates and Prognostic Implications of Optimally Targeted Guideline-Directed Medical Treatment in Heart Failure and Atrial Fibrillation: Insights From The MISOAC-AF Trial

Moysidis

Κάρτας

Samaras

et al. 2023

Journal of Cardiovascular Pharmacology

View full text Add to dashboard Cite

show abstract

“…This phenomenon might be linked to the use of antihypertensive medicines in hypertensive patients, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) medications. ACEIs and ARBs have cardioprotective effects and have been shown to significantly reduce mortality in patients with CHD [ 123 ]. Meanwhile, studies have suggested that angiotensin II was elevated in COVID-19 patients compared to healthy individuals [ 124 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of the pre-existing coronary heart disease on the prognosis of COVID-19 patients: A systematic review and meta-analysis

Wang,

Zhu,

Zhang

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Although studies have shown severe Coronavirus disease 2019 (COVID-19) outcomes in patients with pre-existing coronary heart disease (CHD), the prognosis of COVID-19 patients with pre-existing CHD remains uncertain primarily due to the limited number of patients in existing studies. This study aimed to investigate the impacts of pre-existing CHD on the prognosis of COVID-19 patients. Five electronic databases were searched for eligible studies. This article focused on cohort and case-control studies involving the prognosis of COVID-19 patients with pre-existing CHD. The meta-analysis was performed using a random effects model. The odds ratios (ORs) and 95% confidence intervals (CIs) were used as valid indicators. The study was registered in PROSPERO with the identifier: CRD42022352853. A total of 81 studies, involving 157,439 COVID-19 patients, were included. The results showed that COVID-19 patients with pre-existing CHD exhibited an elevated risk of mortality (OR = 2.45; 95%CI: [2.04, 2.94], P < 0.001), severe/critical COVID-19 (OR = 2.57; 95%CI: [1.98, 3.33], P < 0.001), Intensive Care Unit or Coronary Care Unit (ICU/CCU) admission: (OR = 2.75, 95%CI: [1.61, 4.72], P = 0.002), and reduced odds of discharge/recovery (OR = 0.43, 95%CI: [0.28, 0.66], P < 0.001) compared to COVID-19 patients without pre-existing CHD. Subgroup analyses indicated that the prognosis of COVID-19 patients with pre-existing CHD was influenced by publication year, follow-up duration, gender, and hypertension. In conclusion, pre-existing CHD significantly increases the risk of poor prognosis in patients with COVID-19, particularly in those male or hypertensive patients.

show abstract

“…[3][4][5][6] Recently, even though the ischemia improvement and antiplatelet drugs (such as the beta receptor-blocking agent, statins, and nitrates) have been widely applied in treating CHD patients, the disease continues to progress; besides, their long-term survival is unsatisfied with a 5 years survival rate ranging from 49.3% to 82.9%. [7][8][9][10] Therefore, it is essential to develop the potential biomarker to monitor the disease progression and predict the survival of CHD patients, which might assist the clinicians to stratify CHD patients and individualize them, thus further improving the prognosis of CHD patients.…”

Section: Introductionmentioning

confidence: 99%

Circulating brain‐derived neurotrophic factor dysregulation and its linkage with lipid level, stenosis degree, and inflammatory cytokines in coronary heart disease

Xia

Zeng

Chen

2022

Clinical Laboratory Analysis

View full text Add to dashboard Cite

Background: Brain-derived neurotrophic factor (BDNF) regulates the lipid metabolism, atherosclerosis plaque formation, and inflammatory process, while the study about its clinical role in coronary heart disease (CHD) is few. The present study intended to explore the expression of BDNF and its relationship with stenosis, inflammation, and adhesion molecules in CHD patients.Methods: After serum samples were obtained from 207 CHD patients, BDNF, tumor necrosis factor-alpha (TNFα), interleukin (IL)-1β, IL-6, IL-8, IL-17A, vascular cell adhesion molecule-1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1) levels were determined using ELISA. Then, the BDNF level was also examined in 40 disease controls (DCs) and 40 healthy controls (HCs), separately.Results: BDNF was lower in CHD patients than in DCs and HCs (median (95% confidential interval) value

show abstract

Intensity of Guideline-Directed Medical Therapy for Coronary Heart Disease and Ischemic Heart Failure Outcomes

Cited by 4 publications

References 37 publications

Prescription Rates and Prognostic Implications of Optimally Targeted Guideline-Directed Medical Treatment in Heart Failure and Atrial Fibrillation: Insights From The MISOAC-AF Trial

Prescription Rates and Prognostic Implications of Optimally Targeted Guideline-Directed Medical Treatment in Heart Failure and Atrial Fibrillation: Insights From The MISOAC-AF Trial

Effects of the pre-existing coronary heart disease on the prognosis of COVID-19 patients: A systematic review and meta-analysis

Circulating brain‐derived neurotrophic factor dysregulation and its linkage with lipid level, stenosis degree, and inflammatory cytokines in coronary heart disease

Contact Info

Product

Resources

About