Patient Characteristics From a Regional Multicenter Database of Acute Decompensated Heart Failure in Asia Pacific (ADHERE International–Asia Pacific)

Atherton, J.; Hayward, Christopher; Ahmad, Wan Azman Wan; Kwok, Bernard W.K.; Jorge, Jesus; Hernandez, Adrian F.; Liang, Li; Kociol, Robb D.; Krum, Henry

doi:10.1016/j.cardfail.2011.09.003

Cited by 153 publications

(207 citation statements)

References 23 publications

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“…HF prescription rates for both ACEIs/ARBs and beta-blockers have increased substantially over the past two decades, [23][24][25][26] such that 92 % of patients were on ACEI or ARB therapy and 93 % were on beta-blockers in the recent European Society of Cardiology Heart Failure Longterm Registry, with most of those patients not on treatment having a documented contraindication or previous medication intolerance. 26 Despite this, only 29 % of patients were on target doses of ACEIs and 18 % were on target doses of beta-blockers, with approximately onethird having no reason documented for the failure to up-titrate.…”

Section: Target Dose Achievement In Clinical Practicementioning

confidence: 99%

Expert Comment: Is Medication Titration in Heart Failure too Complex?

Atherton¹,

Hickey²

2017

Cardiac Failure Review

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The prevalence of heart failure (HF) continues to rise, driven by an ageing population, increasing rates of obesity and diabetes, and better survival in patients with cardiovascular disease.1 While HF is associated with substantial morbidity and mortality, a number of treatments have been shown to improve outcomes in large-scale randomised controlled trials (RCT), including pharmacological inhibition of the renin-angiotensin system (with or without neprilysin inhibition), betablockers, mineralocorticoid receptor antagonists, sinus node inhibition, cardiac resynchronisation therapy with biventricular pacing, implantable cardioverter defibrillators and multidisciplinary models of care. [2][3][4] In order to realise the benefits of these treatments, however, we need to consider how patients were selected for these RCT and how the treatments were delivered.The adoption of innovative models of care and the delivery of device therapies can be particularly challenging, given that they are highly dependent on the individual operators and rely on substantial infrastructure and staffing support. At first glance, it would appear that the administration of pharmacological therapies for HF should be relatively straightforward, but such therapies are also highly dependent on the individual prescribers, rely on substantial infrastructure and staffing support, and involve real complexities around medication persistence and patient adherence.In this review, we will discuss medication titration in HF and consider whether or not it is too complex in the real-world setting.We conducted a literature search in November and December 2016 using PubMed. Keywords included 'heart failure', which was used in combination with 'medication' or 'therapy' and 'titration' or 'up-titration', 'dose' or 'target dose'. We also searched reference lists of relevant primary studies and systematic reviews. We used no language or date restrictions. All types of study design were included where medication titration was a primary endpoint. Clinical Trials Evaluating Medications in Heart FailureLarge-scale randomised controlled trials (RCTs) have demonstrated that angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers and mineralocorticoid receptor antagonists all improve clinical outcomes in patients with HF associated with a reduced left ventricular ejection fraction (HFrEF). 5-12Indeed, such studies suggest that the combination of an ACEI, betablocker and mineralocorticoid receptor antagonist should translate to a 60-70 % relative risk reduction in all-cause mortality. 13 Nevertheless, it is likely that the balance between benefit and harm varies according to patient age, disease severity, associated comorbidities and approaches to monitoring and medication titration. An example of the impact of comorbidities was demonstrated by an individual patient data meta-analysis of the beta-blocker RCTs, in which the benefits were only observed in patients in sinus rhythm, there was no reduction in hospitalisation or...

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Section: Target Dose Achievement In Clinical Practicementioning

confidence: 99%

Expert Comment: Is Medication Titration in Heart Failure too Complex?

Atherton¹,

Hickey²

2017

Cardiac Failure Review

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“…Asian patients with heart failure (HF) manifest an aggressive clinical phenotype with younger age at presentation and increased mortality rates compared with those in America or Europe based on registry data 1, 2. Prevalence rates of iron deficiency (ID) in Southeast Asian HF patients also exceed those in European patients, averaging 61% and peaking at 80% in patients of Indian ethnicity 3.…”

Section: Introductionmentioning

confidence: 99%

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

Yeo

Hadi³

et al. 2018

ESC Heart Failure

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AimsIron deficiency is highly prevalent in Southeast Asians with heart failure (HF) and associated with worse outcomes. This trial aimed to assess the effect of intravenous iron in Southeast Asians hospitalized with decompensated HF.Methods and resultsFifty patients hospitalized for acute decompensated HF, regardless of ejection fraction, with iron deficiency (defined as serum ferritin <300 ng/mL if transferrin saturation is <20%) were randomized to receive either one dose of intravenous ferric carboxymaltose (FCM) 1000 mg or placebo (0.9% saline) following HF stabilization and before discharge in two Singapore tertiary centres. The primary endpoint was difference in 6‐min walk test (6MWT) distance over 12 weeks, while secondary endpoints were quality of life assessed using validated Kansas City Cardiomyopathy Questionnaire (KCCQ) and Visual Analogue Scale (VAS). Improvement in 6MWT distance at Week 12 was observed in both FCM and placebo groups (from 252 ± 123 to 334 ± 128 m and from 243 ± 67 to 301 ± 83 m, respectively). Unadjusted analysis showed 6MWT distance for FCM exceeded that for placebo, but adjustment for baseline covariates and time attenuated this effect {adjusted mean difference between groups: 0.88 m [95% confidence interval (CI) −30.2 to 32.0, P = 0.956]}. KCCQ overall summary and VAS were similar in both groups [adjusted mean difference: KCCQ −1.48 (95% CI −8.27 to 5.31, P = 0.670) and VAS 0.26 (95% CI −0.33 to 0.86, P = 0.386)]. FCM was well tolerated with no serious treatment‐related adverse events.ConclusionsIntravenous FCM administered pre‐discharge in Southeast Asians hospitalized with decompensated HF is clinically feasible. Changes in 6MWT distance should be measured beyond Week 12 to account for background therapy effects.

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“…Heart failure (HF) is a global public health problem affecting millions worldwide 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. In the USA, the prevalence is 5.7 million and there are 670 000 new cases per year, while there are another 15 million people living with HF in Europe 13, 14, 15.…”

Section: Introductionmentioning

confidence: 99%

“…1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 These registries have either focused on in‐patient characterization and short‐term outcomes or maintained separate samples of acute HF hospitalizations and chronic HF follow‐up, limiting understanding of the transition from chronic maintenance to an acute state requiring hospitalization 24, 25. No prior detailed, longitudinal evaluations of long‐term disease progression, healthcare utilization, and health economics on a global scale have been reported.…”

Section: Introductionmentioning

confidence: 99%

International REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT‐HF): rationale for and design of a global registry

Filippatos

Khan

Ambrosy

et al. 2015

European J of Heart Fail

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AimsThe clinical characteristics, initial presentation, management, and outcomes of patients hospitalized with new‐onset (first diagnosis) heart failure (HF) or decompensation of chronic HF are poorly understood worldwide. REPORT‐HF (International REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure) is a global, prospective, and observational study designed to characterize patient trajectories longitudinally during and following an index hospitalization for HF.MethodsData collection for the registry will be conducted at ∼300 sites located in ∼40 countries. Comprehensive data including demographics, clinical presentation, co‐morbidities, treatment patterns, quality of life, in‐hospital and post‐discharge outcomes, and health utilization and costs will be collected. Enrolment of ∼20 000 adult patients hospitalized with new‐onset (first diagnosis) HF or decompensation of chronic HF over a 3‐year period is planned with subsequent 3 years follow‐up.PerspectiveThe REPORT‐HF registry will explore the clinical characteristics, management, and outcomes of HF worldwide. This global research programme may have implications for the formulation of public health policy and the design and conduct of international clinical trials.

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Patient Characteristics From a Regional Multicenter Database of Acute Decompensated Heart Failure in Asia Pacific (ADHERE International–Asia Pacific)

Cited by 153 publications

References 23 publications

Expert Comment: Is Medication Titration in Heart Failure too Complex?

Expert Comment: Is Medication Titration in Heart Failure too Complex?

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

International REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT‐HF): rationale for and design of a global registry

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