Rapid uptitration: what's the evidence?

Beldhuis, Iris E.; Voors, Adriaan A.; Tromp, Jasper

doi:10.1002/ejhf.2759

Cited by 2 publications

(8 citation statements)

References 13 publications

(27 reference statements)

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“…Beldhuis et al suggest starting the drug classes in the order of SGLT2i, MRA, ARNI, and then betablocker as fast as possible. ( Beldhuis et al, 2022 ). Packer et al instead advocate starting with a betablocker and SGLT2i, followed by ARNI and MRA in whatever order.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple viewpoints have been published to give shape to the rapid sequencing strategy and to provide guidance to clinicians. ( Greene et al, 2021 ; McMurray and Packer, 2021 ; Packer and McMurray, 2021 ; Beldhuis et al, 2022 ). One of these viewpoints entails selecting the initial therapy and sequencing strategy based on the clinical parameters of the patient, resulting in different patient “profiles”.…”

Section: Introductionmentioning

confidence: 99%

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Phenotypic patient profiling for improved implementation of guideline-directed medical therapy: An exploratory analysis in a large real-world chronic heart failure cohort

et al. 2023

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Aims: Implementation of guideline-recommended pharmacological treatment in heart failure (HF) patients remains challenging. In 2021, the European Heart Failure Association (HFA) published a consensus document in which patient profiles were created based on readily available patient characteristics and suggested that treatment adjusted to patient profile may result in better individualized treatment and improved guideline adherence. This study aimed to assess the distribution of these patient profiles and their treatment in a large real-world chronic HF cohort.Methods and results: The HFA combined categories of heart rate, blood pressure, presence of atrial fibrillation, chronic kidney disease, and hyperkalemia into eleven phenotypic patient profiles. A total of 4,455 patients with chronic HF and a left ventricular ejection fraction ≤40% with complete information on all characteristics were distributed over these profiles. In total, 1,640 patients (36.8%) could be classified into one of the HFA profiles. Three of these each comprised >5% of the population and consisted of patients with a heart rate >60 beats per minute with normal blood pressure (>90/60 mmHg) and no hyperkalemia.Conclusion: Nearly forty percent of a real-world chronic HF population could be distributed over the eleven patient profiles as suggested by the HFA. Phenotype-specific treatment recommendations are clinically relevant and important to further improve guideline implementation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Phenotypic patient profiling for improved implementation of guideline-directed medical therapy: An exploratory analysis in a large real-world chronic heart failure cohort

et al. 2023

View full text Add to dashboard Cite

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“…Beldhuis et al advocate initiating an SGLT2i first, then an MRA, followed by ARNI, and lastly a BB. 13 Rosano et al have proposed the use of patient profiling to provide more specific recommendations according to phenotypic HF profile; however, this initiative is new and validation in clinical practice is not available. 16,26 Importantly, the recent STRONG-HF trial provides direct RCT evidence that simultaneous and rapid sequence initiation and titration of GDMT for HF is safe, well tolerated, and effective for reducing death and HF hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have supported this recommendation and show the link between a short implementation time‐frame and reduced mortality, 9–11 of which the results were confirmed in the STRONG‐HF trial 12 . In order to optimize the drug implementation process, several sequencing strategies have been suggested, as summarized in Figure 13–16 …”

Section: Introductionmentioning

confidence: 92%

“…12 In order to optimize the drug implementation process, several sequencing strategies have been suggested, as summarized in Figure 1. [13][14][15][16] Despite the evidence favouring a high-intensity and rapid sequencing approach as described in STRONG-HF, the question of practical feasibility remains. In the first 3 months, patients in the high-intensity group had an average of five clinic visits compared with one visit in the usual care group.…”

Section: Introductionmentioning

confidence: 99%

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Guideline implementation, drug sequencing, and quality of care in heart failure: design and rationale of TITRATE‐HF

Clephas,

Malgie,

Schaap

et al. 2023

ESC Heart Failure

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AimsCurrent heart failure (HF) guidelines recommend to prescribe four drug classes in patients with HF with reduced ejection fraction (HFrEF). A clear challenge exists to adequately implement guideline‐directed medical therapy (GDMT) regarding the sequencing of drugs and timely reaching target dose. It is largely unknown how the paradigm shift from a serial and sequential approach for drug therapy to early parallel application of the four drug classes will be executed in daily clinical practice, as well as the reason clinicians may not adhere to new guidelines. We present the design and rationale for the real‐world TITRATE‐HF study, which aims to assess sequencing strategies for GDMT initiation, dose titration patterns (order and speed), intolerance for GDMT, barriers for implementation, and long‐term outcomes in patients with de novo, chronic, and worsening HF.Methods and resultsA total of 4000 patients with HFrEF, HF with mildly reduced ejection fraction, and HF with improved ejection fraction will be enrolled in >40 Dutch centres with a follow‐up of at least 3 years. Data collection will include demographics, physical examination and vital parameters, electrocardiogram, laboratory measurements, echocardiogram, medication, and quality of life. Detailed information on titration steps will be collected for the four GDMT drug classes. Information will include date, primary reason for change, and potential intolerances. The primary clinical endpoints are HF‐related hospitalizations, HF‐related urgent visits with a need for intravenous diuretics, all‐cause mortality, and cardiovascular mortality.ConclusionsTITRATE‐HF is a real‐world multicentre longitudinal registry that will provide unique information on contemporary GDMT implementation, sequencing strategies (order and speed), and prognosis in de novo, worsening, and chronic HF patients.

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Rapid uptitration: what's the evidence?

Cited by 2 publications

References 13 publications

Phenotypic patient profiling for improved implementation of guideline-directed medical therapy: An exploratory analysis in a large real-world chronic heart failure cohort

Phenotypic patient profiling for improved implementation of guideline-directed medical therapy: An exploratory analysis in a large real-world chronic heart failure cohort

Guideline implementation, drug sequencing, and quality of care in heart failure: design and rationale of TITRATE‐HF

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