Patient profiling in heart failure for tailoring medical therapy. A consensus document of the <scp>Heart Failure Association of the European Society of Cardiology</scp>

Rosano, Giuseppe; Moura, Brenda; Metra, Marco; Böhm, Michael; Bauersachs, Johann; Gal, Tuvia Ben; Adamopoulos, Stamatis; Abdelhamid, Magdy; Bistola, Vasiliki; Čelutkienė, Jelena; Chioncel, Ovidiu; Farmakis, Dimitrios; Ferrari, Roberto; Filippatos, Gerasimos; Hill, Loreena; Jankowska, Ewa A.; Jaarsma, Tiny; Jhund, Pardeep S.; Lainščak, Mitja; Lopatin, Yuri; Lund, Lars H.; Miličić, Davor; Mullens, Wilfried; Pinto, Fausto J.; Ponikowski, Piotr; Savarese, Gianluigi; Thum, Thomas; Volterrani, Maurizio; Anker, Stefan D.; Seferović, Petar; Coats, Andrew J.S.

doi:10.1002/ejhf.2206

Cited by 195 publications

(257 citation statements)

References 68 publications

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“…Thus, as for ARNI, there is ample evidence for an early introduction of SGLT2i in the treatment of HFrEF patients. As the mechanism of action of SGLT2i is independent from a reduction of neuroendocrine activation, these drugs, when possible, should be used in combination with standard neuro-hormonal antagonists or ARNI [2][3][4][5][6][7].…”

Section: Sodium-glucose Co-transporters 2 Inhibitors (Sglt2i)mentioning

confidence: 99%

“…These new drugs, namely, angiotensin receptor/neprilysin inhibitors (ARNI), sodium-glucose transporter 2 inhibitors (SGLT2i), sodium guanylate cyclase (SGC) modulators, and myosin activators, have shown to further increase survival and/or hospitalization for patients with HFrEF and are, or soon will be, available for HFrEF treatment. In anticipation of the new guidelines, several suggestions on how to integrate these treatments have been proposed [3][4][5][6][7]. The suggestions are based on the relative efficacy of each drug to achieve the pre-determined endpoints, with the aim to produce an integrated scheme related to the use of the new treatments in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…The difficulty is amplified in the "real world" given the reluctance of practitioners to adhere to schematic guidelines' recommendations for multiple reasons, including tolerability, which usually is related to low blood pressure, heart rate, poor kidney function, or hyperkalemia. This is particularly so in elderly patients with several comorbidities and multiple pharmacotherapies [2][3][4][5][6][7][8]. In this review, we followed a different approach.…”

Section: Introductionmentioning

confidence: 99%

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Looking for a Tailored Therapy for Heart Failure: Are We Capable of Treating the Patient Instead of the Disease?

Fucili

Cimaglia

Severi

et al. 2021

JCM

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After almost a decade of stagnation in clinical research for HF treatment, five large randomized trials recently published have supported the use of four new classes of drugs, namely: angiotensin receptor/neprilysin inhibitor, sodium–glucose co-transporters 2 inhibitors, soluble guanylate cyclase modulators, and myosin activators. Each treatment has proved to be beneficial for both long-term outcomes and quality of life. Beside their clinical relevance, all these novel treatments have a different mechanism of action beyond the usual neuro-hormonal blockage. These different pathways, together with the unquestionable clinical evidence, advocate a re-thinking of HF treatment and of the appropriate drug to integrate with the existing standard therapy, according to different characteristics of HFrEF patients. This study aimed to offer a synthetic overview of the mechanisms of action of the new drugs and to propose a more personalized approach, considering patients’ characteristics and safety profiles. To this end, we have identified seven profiles for patients with chronic heart failure with reduced ejection fraction and two for pre-discharge patients.

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Section: Sodium-glucose Co-transporters 2 Inhibitors (Sglt2i)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Looking for a Tailored Therapy for Heart Failure: Are We Capable of Treating the Patient Instead of the Disease?

Fucili

Cimaglia

Severi

et al. 2021

JCM

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“…The authors of the position paper highlight that the immediate period after hospital discharge is very important, as it carries a very high risk of another exacerbation. There is evidence that HFrEF patients receiving guideline-directed medical therapy (GDMT) have a better prognosis at discharge [24].…”

Section: Barriers To Implementation Of Hf Therapymentioning

confidence: 99%

“…The authors of the consensus document identify nine phenotypes of patients with individual needs for dose up-titration [24]: 1. Patients with low blood pressure and high heart rate…”

Section: Patient Phenotyping For Targeted Therapiesmentioning

confidence: 99%

Dapagliflozin in the treatment of patients with heart failure with reduced left ventricular ejection fraction – a practical approach

Nessler

2021

pwki

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Because of its frequent occurrence, poor prognosis, low quality of life of patients accompanying the disease and high costs associated with treatment heart failure is a significant health problem in modern cardiology. The treatment of patients with heart failure and reduced ejection fraction (HFrEF) is supported by large-scale randomized clinical trials (RCTs), reflected in the ESC/HFA treatment recommendations. The use of β-blockers, inhibitors of the renin-angiotensin aldosterone system (RAA), including angiotensin converting enzyme ACE/ARB inhibitors, angiotensin and neprilysin receptor blockers (ARNI) and mineralocorticoid receptor antagonists (MRA) have been a solid basis for triple HFrEF therapy over the last few years, partially altering the natural history of patients with HF. Despite this, the 5-year survival rate in HF is still lower than for some types of cancer. Therefore, the search for new drugs to improve the prognosis of this disease is still ongoing. A new group of drugs -the so-called flozins, i.e. -is a great hope for a change in the natural history of heart failure. The following article presents practical aspects of using these drugs in the treatment of patients with HFrEF, taking into account both the inclusion criteria and various clinical profiles of patients.

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Pharmacotherapy treatment patterns at hospital discharge and clinical outcomes among patients with heart failure with reduced ejection fraction

Wongsalap

Poolpun

Keawhai

et al. 2023

Chronic Diseases and Translational Medicine

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Background: This study aimed to assess the prescribing patterns of evidencebased pharmacotherapy and their association with clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) in Thailand. Methods: A retrospective cohort study of patients with HFrEF was conducted. Treatment with a β-blocker and renin-angiotensin system inhibitors (RASIs) with or without mineralocorticoid receptor antagonists (MRAs) at discharge was regarded as guideline-directed medical therapy (GDMT). All others were considered non-GDMT. The primary endpoint was the composite of all-cause mortality or heart failure (HF) rehospitalization. Inverse-probabilitytreatment-weighted adjusted Cox proportional hazard models were used to examine the treatment effects. Results: In total, 653 patients with HFrEF (mean age 64.1 ± 14.3 years; 55.9% male) were included. GDMT with β-blockers and RASIs with or without MRAs was prescribed at a rate of 35.4%. During a median of 1-year follow-up, 167 patients (27.5%) had a composite event, 81 patients (13.3%) had all-cause mortality, and 109 patients (18.0%) had HF rehospitalization. Patients treated with GDMT at discharge showed significantly lower rates of the primary endpoint (adjusted hazard ratio [HR] 0.63; 95% CI 0.44-0.89; p = 0.009) compared with patients who did not receive GDMT. The use of GDMT was also associated with a significantly lower risk of all-cause mortality (adjusted HR 0.59; 95% CI 0.36-0.98; p = 0.045) and HF rehospitalization (adjusted HR 0.65; 95% CI 0.43-0.96; p = 0.031). Conclusions: For HFrEF treatment, GDMT initiation at hospital discharge was associated with a significantly reduced risk of all-cause mortality and HF rehospitalization. Nevertheless, prescribing GDMT remains underused, and it could be encouraged to improve HF outcomes in real-world settings.

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Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology

Cited by 195 publications

References 68 publications

Looking for a Tailored Therapy for Heart Failure: Are We Capable of Treating the Patient Instead of the Disease?

Looking for a Tailored Therapy for Heart Failure: Are We Capable of Treating the Patient Instead of the Disease?

Dapagliflozin in the treatment of patients with heart failure with reduced left ventricular ejection fraction – a practical approach

Pharmacotherapy treatment patterns at hospital discharge and clinical outcomes among patients with heart failure with reduced ejection fraction

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