Management of Heart Failure with Reduced Ejection Fraction after ESC 2016 Heart Failure Guidelines: The Linx Registry

Abstract

Aims In May 2016, a new version of the European Society of Cardiology (ESC) Guidelines for the management of heart failure (HF) was released. The aim of this study was to describe the management of HF with reduced ejection fraction after the publication of ESC Guidelines. Methods and results The Linx registry is a multicentre, observational, cross‐sectional study from 14 Catalan hospitals that enrolled 1056 patients with HF and reduced left ventricular ejection fraction (≤40%) from 1 February to 30 April 2017 in outpatient cardiology clinics. Results were compared between hospitals according to their level of complexity in our own registry and compared with previously published registries similar to ours. Sacubitril/valsartan was prescribed to 23.9% of patients in our population, as a consequence, use of angiotensin‐converting enzyme inhibitor and angiotensin receptor blockers in monotherapy decreased to 48.1% and 16.9%, respectively, and prescription of beta‐blockers (91.8%), mineralocorticoid receptor antagonists (72.7%), and ivabradine (21.4%) remained similar to previous registries. Target doses of beta‐blockers (25.4%), angiotensin‐converting enzyme inhibitors (24.9%), angiotensin receptor blockers (7.7%), sacubitril/valsartan (8.1%), and mineralocorticoid receptor antagonists (19.7%) were accomplished in a low proportion of patients. Our results also suggest that prescription and up‐titration of class I HF drugs were greater in hospitals with higher level of complexity. Conclusions The Linx registry shows an appropriate adherence to pharmacological recommendations from ESC HF Guidelines despite a low proportion of patients reached target doses. Almost one‐quarter of patients were under treatment with sacubitril/valsartan a few months after ESC HF Guidelines recommendations.

Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria

“…The Linx Registry, one of the most recent HF studies in Spain, also had a large sample of patients and was carried out in cardiology departments in Catalonia. In that registry, de Frutos et al [ 39 ] estimated that the prevalence of NYHA functional class II–IV in patients with HF and EF ≤ 40% was 85.5%, remarkably close to the estimate obtained in the present study.…”

A Simple Score to Identify Super-Responders to Sacubitril/Valsartan in Ambulatory Patients With Heart Failure

“…We consider that its use could imply several clinical benefits, especially in three scenarios. First, it would help its implementation in daily clinical practice, which until now has been slower than expected in different countries ( DeVore et al, 2018 ; Wachter et al, 2019a ; de Frutos et al, 2020 ). Selecting patients with a super-response could be particularly helpful in health systems where resources are limited ( Krittayaphong and Permsuwan, 2018 ; Kahn et al, 2020 ).…”

Comparison of infection risks and clinical outcomes in patients with and without SARS‐CoV‐2 lung infection under renin–angiotensin–aldosterone system blockade: Systematic review and meta‐analysis

“…Several independent studies have reported that the heart and potentially the kidney seem to be—in addition to the respiratory tract—a primary target of SARS‐CoV‐2 infections leading to clinical signs of myocarditis and heart failure 102–105 and potentially renal failure 106,107 . The RAAS is activated in heart failure patients and RAAS blockade is a clinical mainstay in the treatment of heart failure 108–110 In patients with severe pneumonia requiring intensive care treatment, there is a compensatory activation of the RAAS and sympathetic nervous systems, resulting in tachycardia and an elevation of systemic vascular resistance that may be deleterious in this setting 7 .…”