Is an Admission for Decompensated Heart Failure Inevitable?

Blood, Anne J.; Fraiche, Ariane M.; Eapen, Zubin J.

doi:10.1016/j.pcad.2017.07.003

Cited by 10 publications

(4 citation statements)

References 39 publications

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“…Despite the proportion of high-dose ARNI recipients in large pivotal trials, the adherence to multidrug therapy remains a challenging item in clinical practice, even if adults with cardiovascular diseases are prone to polypharmacy due to comorbidities and complexity of medication regimens [ 15 , 16 ]. Though we have already observed drug-related benefit in patients at a high risk of arrhythmic disorders, high-dose ARNI therapy has some practical limitations, especially in patients with low BP symptoms [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Low- vs high-dose ARNI effects on clinical status, exercise performance and cardiac function in real-life HFrEF patients

Corrado

Dattilo

Coppola

et al. 2021

Eur J Clin Pharmacol

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Purpose Only a few studies are available on dose-related effects of sacubitril/valsartan (angiotensin receptor neprilysin inhibition (ARNI)) in real-life patients with heart failure and reduced ejection fraction (HFrEF). We sought to investigate clinical and functional effects in real-life HFrEF patients receiving ARNI at a different cumulative dose. Methods This was an observational study in consecutive outpatients admitted for HFrEF from October 2017 to June 2019. The PARADIGM criteria were needed for enrolment. ARNI was uptitrated according to blood pressure, drug tolerability, renal function and kaliemia. At least 10-month follow-up was required in each patient. Clinical assessment, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, 6-min walk test and strain echocardiography were performed in each patient on a regular basis during the observational period. At the end of the study, patients were divided into two groups based on the median yearly dose of the ARNI medication. Results A total of 90 patients, 64 ± 11 years, 82% males, were enrolled. The cut-off dose was established in 75 mg BID, and the study population was divided into group A (≤ 75 mg), 52 patients (58%), and group B (> 75 mg), 38 patients (42%). The follow-up duration was 12 months (range 11–13). NYHA class, KCCQ score and 6MWT performance ameliorated in both groups, with a quicker time to benefit in group B. The proportion of patients walking > 350 m increased from 21 to 58% in group A ( p < 0.001), and from 29 to 82% in group B ( p < 0.001). A positive effect was also disclosed in the left ventricular remodelling, strain deformation and diastolic function. Conclusion One-year ARNI treatment was effective in our real-life HFrEF patient population, leading to clinical and functional improvement in both study groups, slightly greater and with a shorter time to benefit in group B. Supplementary information The online version contains supplementary material available at 10.1007/s00228-021-03210-0.

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Section: Discussionmentioning

confidence: 99%

Low- vs high-dose ARNI effects on clinical status, exercise performance and cardiac function in real-life HFrEF patients

Corrado

Dattilo

Coppola

et al. 2021

Eur J Clin Pharmacol

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“…HF leads to a deterioration of the patient's quality of life as well as an increased risk of complications and hospital admissions, despite improvements in management and pharmacotherapy [12,13]. Anticoagulation with anti-vitamin K drugs in these patients could worsen this situation by increasing the risk of hospitalization in those who have suboptimal anticoagulation control [14].…”

Section: Introductionmentioning

confidence: 99%

Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine

et al. 2021

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Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission.

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“…These patients represent approximately a third of the 15.4 millions who suffer from cardiovascular diseases such as hypertension and coronary artery disease, which affect the heart, and stroke (Shim, 2014). The prevalence of HF is expected to increase by 46% from 2012-2030, along with increased costs to tax payers (Blood, Fraiche, and Eapen, 2017).…”

Section: The Hospital Readmissions Reduction Program (Hrrp)mentioning

confidence: 99%

Equity-Efficiency Tradeoff: The Hospital Readmissions Reduction Program and Disparities in Outcomes among Vulnerable Medicare Heart Failure Patients in Pennsylvania

de Lancer Julnes,

Choi

2020

Journal of Health and Human Services Administration

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The Hospital Readmissions Reduction Program (HRRP), a penalty-based pay for performance policy mandated by the 2010 Affordable Care Act, aims to improve health care quality for seniors and cut costs by avoiding readmissions but may disproportionally affect disadvantaged populations. Our study using patient-level survival analysis of data on outcomes for Medicare beneficiaries age 65 years and older who were discharged with heart failure from Pennsylvania inpatient prospective payment systems hospitals from 2010 to 2015, confirm that risk -adjusted readmissions have decreased but the likelihood of mortality has increased for some patients. Non- White heart patients and those living in lower income areas had higher risk of readmission within 30-day and one-year of discharge. Patients living in lower income areas also had a higher risk of mortality than those in more affluent communities. Findings suggest unintended consequences and the need for policy makers and administrators to address the social determinants of health.

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Is an Admission for Decompensated Heart Failure Inevitable?

Cited by 10 publications

References 39 publications

Low- vs high-dose ARNI effects on clinical status, exercise performance and cardiac function in real-life HFrEF patients

Low- vs high-dose ARNI effects on clinical status, exercise performance and cardiac function in real-life HFrEF patients

Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine

Equity-Efficiency Tradeoff: The Hospital Readmissions Reduction Program and Disparities in Outcomes among Vulnerable Medicare Heart Failure Patients in Pennsylvania

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