Registry in Germany focusing on level-specific and evidence-based decision finding in the treatment of heart failure: REFLECT-HF

Tebbe, Ulrich; Tschöpe, Carsten; Wirtz, Jost Henner; Lokies, Jan; Turgonyi, Eva; Bramlage, Peter; Strunz, Anke M.; Lins, Katharina; Böhm, Michael

doi:10.1007/s00392-014-0678-2

Cited by 28 publications

(22 citation statements)

References 31 publications

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“…Results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) and the Multicenter Automatic Defibrillator Implantation Trial (MADITHeart Fail Rev (2015) 20:545-552 547 CRT) indicated that the addition of ICD and/or CRT to pharmacological treatment improved survival in this patient population [18,21,23].…”

Section: Results From Clinical Trials and Patient Registries On The Tmentioning

confidence: 97%

“…REFLECT-HF (REgistry in Germany Focusing on Levelspecific and Evidence-based deCision finding in the Treatment of HF) was a cross-sectional, observational survey that involved the three main types of physicians who care for patients with HF in Germany: hospital-based cardiologists, office-based cardiologists, and general practitioners [23,26]. Between January 16, 2012, and August 30, 2012, a total of 384 patients with confirmed HF in addition to NYHA class II-IV symptoms and/or a LVEF of \50 % were enrolled ( [16,26].…”

Section: Reflect-hf (Germany)mentioning

confidence: 99%

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A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms

et al. 2015

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Heart failure (HF) is commonly described according to the severity of symptoms, using the New York Heart Association (NYHA) classification, and the assessment of ventricular function, by measuring the left ventricular ejection fraction (LVEF). It is important to acknowledge, however, that the severity of symptoms does not systematically correlate with the level of ventricular systolic dysfunction. Patients with no or only mild symptoms are still at high risk of HF-related morbidity and mortality. The objective of this review was to summarize the prevalence, characteristics, and treatment of patients with chronic HF and mild or no symptoms and to review epidemiological data from three recent registries conducted in Europe. From a clinical practice perspective, patients with a reduced ejection fraction who have only mild symptoms appear to represent a group of patients for whom the provision of adequate medical care is yet to be optimized. While prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers appears to be consistently high, the use of mineralocorticoid receptor antagonists is more variable and does not appear to be in accordance with the latest clinical guidelines. As approximately half of patients with HF and a reduced LVEF have NYHA class II symptoms, significant reductions in morbidity and mortality could be achieved by more comprehensive treatment of this population.

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Section: Results From Clinical Trials and Patient Registries On The Tmentioning

confidence: 97%

Section: Reflect-hf (Germany)mentioning

confidence: 99%

A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms

et al. 2015

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“…The present subanalysis extends the initial findings of the REFLECT‐HF survey by investigating the differences in treatment patterns for patients with reduced LVEF (defined as ≤35%) and either NYHA class II or NYHA class III/IV symptoms. Because patients defined as having NYHA class II heart function have only mild symptoms, both the diagnosis and treatment of these patients is potentially more challenging than for those with overt disease.…”

Section: Discussionmentioning

confidence: 86%

“…Data from the primary REFLECT‐HF analysis, which included an evaluation of the rate of prescription of each drug class according to physician type, indicate that MRAs were more frequently prescribed by OBCs than HBCs and GPs. Interestingly, the REFLECT‐HF analysis also demonstrated that the proportion of patients who were eligible for an MRA but did not receive treatment was greater for those who saw an HBC or an OBC than for those who saw a GP …”

Section: Discussionmentioning

confidence: 99%

Treatment of Heart Failure in Real‐World Clinical Practice: Findings From the REFLECT‐HF Registry in Patients With NYHA Class II Symptoms and a Reduced Ejection Fraction

Böhm

Tschöpe

Wirtz

et al. 2015

Clinical Cardiology

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Background: Optimal medical therapy (OMT) for patients with chronic heart failure and a reduced ejection fraction (HF-REF) includes angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and mineralocorticoid receptor antagonists, plus a diuretic. Hypothesis: We hypothesized that OMT is less often prescribed in HF-REF patients (≤35%) with New York Heart Association (NYHA) class II symptoms compared with those with NYHA class III/IV symptoms. Methods: This was a cross-sectional, observational, multicenter survey of hospital-based cardiologists, office-based cardiologists, and general practitioners in Germany. For angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and β-blockers, prescription rates were high and comparable between groups. However, prescription rates for mineralocorticoid receptor antagonists were lower compared with other guideline-recommended treatments. Multivariate analyses indicated that OMT prescription was reduced for older patients and increased for patients cared for by an office-based cardiologist. Conclusions: Given the high proportion of patients with reduced left ventricular systolic function but only minor symptoms, HF-REF appears to be underdiagnosed, and a higher proportion of patients than are currently recognized could potentially be candidates for OMT.

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“…[2][3][4]. Through shared CV diseases, CV risk factors and pathophysiological mechanisms of development of HF, chronic blockade of underlying hyperactivity of both sympathetic and renin-angiotensin (RAS) systems is considered a key factor to improve survival among patients with HF originated due to different aetiologies [5]. Indeed, angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) have been demonstrated multiple beneficial effects on survival associated with prevention of target organ damages.…”

Section: Introductionmentioning

confidence: 99%

The Metabolic Effects of Mineralocorticoid Receptor Antagonists in Heart Failure Patients

Berezin¹

2015

Cardiol Pharmacol

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Heart failure (HF) remains a leading cause of cardiovascular morbidity and mortality worldwide. Mineralocorticod receptor (MR) antagonists (spironolactone and eplerenone) have been studied in HF patients and in patients with acute coronary syndrome or post-myocardial infarction and left ventricular (LV) dysfunction, as well as hypertensive subjects without HF symptoms. It has suggested that mineralocorticoid receptor antagonists provide cardiovascular protection beyond its diuretic and potassium-sparing capacities. Traditionally, progression of HF relates with not full blockade of renin-angiotensin system (RAS) activation and with so called "escape" phenomenon of neurohumoral activation from effects of angiotensin converting enzyme / angiotensin receptor blockers and beta-adrenoblockers. Circulating and local aldosteron over production is discussed a main cause of none adequate effect of RAS blockade contributed negative cardiovascular remodelling and worse survival. During the last decade, several studies have shown that completed control for RAS activation might be achieved through adding MR antagonists in contemporary treatment scheme. This approach raises survival and leads to a trend in declined mortality rate in patients with HF various etiologic causes. Therefore, there are increasing evidence that both MR antagonists spironolactone and eplerenone might have a different metabolic effect in HF patients and that this difference is required to pay attention in creating of optimal HF therapeutic program. The aim of the mini review is to evaluate clinically significance of metabolic effects of mineralocorticoid receptor antagonists in HF patients.

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Registry in Germany focusing on level-specific and evidence-based decision finding in the treatment of heart failure: REFLECT-HF

Cited by 28 publications

References 31 publications

A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms

A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms

Treatment of Heart Failure in Real‐World Clinical Practice: Findings From the REFLECT‐HF Registry in Patients With NYHA Class II Symptoms and a Reduced Ejection Fraction

The Metabolic Effects of Mineralocorticoid Receptor Antagonists in Heart Failure Patients

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