Patient Eligibility for Established and Novel Guideline-Directed Medical Therapies After Acute Heart Failure Hospitalization

Moghaddam, Nima; Hawkins, Nathaniel M.; McKelvie, Robert S.; Poon, Stephanie; Joncas, Sebastien X; MacFadyen, John R.; Honos, George; Wang, Jia; Rojas‐Fernandez, Carlos; Kok, Melanie; Sidhu, Vishaldeep; Zieroth, Shelley; Virani, Sean

doi:10.1016/j.jchf.2022.10.013

Cited by 9 publications

(7 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Median age was 73 years in our study, whereas mean age was 72 years in a study from the CAN‐HF (Canadian Heart Failure Registry). 18 The prevalence of female sex (≈30%) is similar in other contemporary registries, whereas the baseline eGFR is slightly higher in our patients (61.5 versus 54.4 mL/min per 1.73 m 2 in CAN‐HF). 18 , 19 …”

Section: Discussionsupporting

confidence: 81%

See 1 more Smart Citation

Eligibility for the 4 Pharmacological Pillars in Heart Failure With Reduced Ejection Fraction at Discharge

D'Amario,

Rodolico,

Delvinioti

et al. 2023

JAHA

View full text Add to dashboard Cite

Background Guidelines recommend using multiple drugs in patients with heart failure (HF) with reduced ejection fraction, but there is a paucity of real‐world data on the simultaneous initiation of the 4 pharmacological pillars at discharge after a decompensation event. Methods and Results A retrospective data mart, including patients diagnosed with HF, was implemented. Consecutively admitted patients with HF with reduced ejection fraction were selected through an automated approach and categorized according to the number/type of treatments prescribed at discharge. The prevalence of contraindications and cautions for HF with reduced ejection fraction treatments was systematically assessed. Logistic regression models were fitted to assess predictors of the number of treatments (≥2 versus <2 drugs) prescribed and the risk of rehospitalization. A population of 305 patients with a first episode of HF hospitalization and a diagnosis of HF with reduced ejection fraction (ejection fraction, <40%) was selected. At discharge, 49.2% received 2 current recommended drugs, β‐blockers were prescribed in 93.4%, while a renin‐angiotensin system inhibitor or an angiotensin receptor–neprilysin inhibitor was prescribed in 68.2%. A mineralocorticoid receptor antagonist was prescribed in 32.5%, although none of the patients showed contraindications to mineralocorticoid receptor antagonist prescription. A sodium‐glucose cotransporter 2 inhibitor could be prescribed in 71.1% of patients. On the basis of current recommendations, 46.2% could receive the 4 foundational drugs at discharge. Renal dysfunction was associated with <2 foundational drugs prescribed. After adjusting for age and renal function, use of ≥2 drugs was associated with lower risk of rehospitalization during the 30 days after discharge. Conclusions A quadruple therapy could be directly implementable at discharge, potentially providing prognostic advantages. Renal dysfunction was the main prevalent condition limiting this approach.

show abstract

Section: Discussionsupporting

confidence: 81%

“… 18 The prevalence of female sex (≈30%) is similar in other contemporary registries, whereas the baseline eGFR is slightly higher in our patients (61.5 versus 54.4 mL/min per 1.73 m 2 in CAN‐HF). 18 , 19 …”

Section: Discussionsupporting

confidence: 81%

Eligibility for the 4 Pharmacological Pillars in Heart Failure With Reduced Ejection Fraction at Discharge

D'Amario,

Rodolico,

Delvinioti

et al. 2023

JAHA

View full text Add to dashboard Cite

show abstract

“…Our considerably lower estimate for the trial scenario (21%) might be due to the application of a larger number of the exclusion criteria of GALAC-TIC-HF, enabled by the use of our well-characterized HF registry. In 455 patients hospitalized for acute HFrEF in the Canadian HF (CAN-HF) registry, eligibility according to GALAC-TIC-HF enrolment criteria was estimated at 30% [25], which is again than our estimates in chronic HFrEF (21%) but considerably lower than the ones for in-patients (57%). This discrepancy is likely explained by their use of a strict interpretation of the OMT criterion (i.e.…”

Section: Discussioncontrasting

confidence: 78%

“…This discrepancy is likely explained by their use of a strict interpretation of the OMT criterion (i.e. patients were required to receive RASi/ARNI+betablocker+MRA to be eligible), which was unmet by 30% of patients in CAN-HF [25]. We performed a trial scenario sensitivity analysis with a similarly strict interpretation of the OMT criterion, which was met only by 42% of our cohort and yielded an overall trial eligibility of only 10%.…”

Section: Discussionmentioning

confidence: 99%

Eligibility for omecamtiv mecarbil in a real-world heart failure population: Data from the Swedish Heart Failure Registry

Lindberg,

Øigaard,

Metra

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

Aims We assessed eligibility for omecamtiv mecarbil (OM) in a real-world cohort with heart failure with reduced ejection fraction (HFrEF) according to the selection criteria of the GALACTIC-HF trial (trial scenario) and selected trial´s criteria more likely to impact real-world use (pragmatic scenario). Methods and results We included 31,015 patients with HFrEF lasting ≥3 months and registered in the Swedish HF registry between 2000–2021. Trial eligibility was calculated by applying all the GALACTIC-HF selection criteria. The pragmatic scenario considered only the New York Heart Association class, history of worsening HF, N-terminal pro-B-type natriuretic peptides (NT-proBNP), blood pressure and renal failure criteria defined as in the trial. Eligibility for OM in chronic HFrEF was 21% and 36% in the trial and pragmatic scenarios, respectively. Eligibility was higher in those with EF<30% (trial: 27%, pragmatic: 44%), in-patients (trial:30%, pragmatic:57%), severe HF (trial: 35%, pragmatic: 60%), NYHA class III-IV (trial: 26%, pragmatic: 45%), and NT-proBNP≥5,000pg/mL (trial: 30%, pragmatic: 51%). The criteria that most limited eligibility were history of a recent worsening HF event (60% eligible in chronic HFrEF), elevated NT-proBNP (82% eligible), and deviating blood pressure (82% eligible). Overall, eligible patients were characterized by more severe HF and higher CV event-rates in both scenarios, and higher comorbidity burden in the pragmatic scenario. Conclusion Approximately 21% of real-world chronic HFrEF patients would be eligible for OM according to the GALACTIC-HF selection criteria, and 36% according to the criteria more likely to affect OM use in clinical practice. Criteria in both scenarios identified a patient-group with severe HF and high CV event-rates.

show abstract

“…Registries can also inform on the design of more generalizable RCTs by highlighting gaps of representation. [188][189][190][191][192][193] Real-world data can also contribute to structure accurate healthcare plans and improve resource allocation. 157 Registries and EHR can also be used as a screening tool to identify need of and guide treatment implementation.…”

Section: Real-world Data and Quality Registriesmentioning

confidence: 99%

How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the Heart Failure Association of the ESC

Savarese,

Lindberg,

Cannata

et al. 2024

European J of Heart Fail

View full text Add to dashboard Cite

Guideline‐directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF) reduces morbidity and mortality, but its implementation is often poor in daily clinical practice. Barriers to implementation include clinical and organizational factors that might contribute to clinical inertia, i.e. avoidance/delay of recommended treatment initiation/optimization. The spectrum of strategies that might be applied to foster GDMT implementation is wide, and involves the organizational set‐up of heart failure care pathways, tailored drug initiation/optimization strategies increasing the chance of successful implementation, digital tools/telehealth interventions, educational activities and strategies targeting patient/physician awareness, and use of quality registries. This scientific statement by the Heart Failure Association of the ESC provides an overview of the current state of GDMT implementation in HFrEF, clinical and organizational barriers to implementation, and aims at suggesting a comprehensive framework on how to overcome clinical inertia and ultimately improve implementation of GDMT in HFrEF based on up‐to‐date evidence.

show abstract

Patient Eligibility for Established and Novel Guideline-Directed Medical Therapies After Acute Heart Failure Hospitalization

Cited by 9 publications

References 37 publications

Eligibility for the 4 Pharmacological Pillars in Heart Failure With Reduced Ejection Fraction at Discharge

Eligibility for the 4 Pharmacological Pillars in Heart Failure With Reduced Ejection Fraction at Discharge

Eligibility for omecamtiv mecarbil in a real-world heart failure population: Data from the Swedish Heart Failure Registry

How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the Heart Failure Association of the ESC

Contact Info

Product

Resources

About