Role of Guideline Directed Medical Therapy Doses and Optimization in Patients Hospitalized With Decompensated Systolic Heart Failure

Grewal, Dennis; Partow-Navid, Rod; Garcia, Dante; Coney, Joshua; Fraser, Gary E.; Stoletniy, Liset; Sakr, Antoine; Parwani, Purvi; Abramov, Dmitry

doi:10.1016/j.amjcard.2021.04.017

Cited by 10 publications

(9 citation statements)

References 17 publications

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“…However, given a high incidence of suboptimal compliance, optimization of GDMT in the MethHF population is challenging. Optimization of GDMT among hospitalized systolic HF patients has been shown to be feasible and associated with improved outcomes [21]. In this cohort, we found that patients with MethHF are discharged with overall similar GDMT to the non-MethHF patients, implying that the use of GDMT in this population appears feasible and may be an important step in improving outcomes, concurrent with substance cessation counseling.…”

Section: Discussionmentioning

confidence: 63%

Echocardiographic Parameters and Outcomes in Methamphetamine-Associated Heart Failure: A Propensity Score-Weighted Analysis

et al. 2022

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Background: Methamphetamines are a common cause of systolic heart failure (HF). There are limited data on the prognosis associated with hospitalizations for decompensated HF in the setting of methamphetamine use. We aimed to evaluate patient characteristics and outcomes among patients admitted with decompensated HF who had positive drug screens for amphetamines as well as to determine whether any parameters from transthoracic echocardiogram (TTE) can predict outcomes in this population. Methods:This was a retrospective cohort study of consecutive adult patients admitted to the Loma Linda Medical Center who had an active hospital problem of acute on chronic systolic (or systolic and diastolic) HF from 2013 to 2018. Electronic medical records were mined for relevant patient data. Methamphetamine-associated heart failure (MethHF) group was defined as those with an admission urine drug screen (UDS) that was positive for methamphetamines, whereas non-MethHF was defined by patients with negative methamphetamine on UDS or UDS was not done on physician's discretion. The primary outcomes of the study were 30-day composite outcome (defined as combined all-cause readmission and all-cause mortality), 365-day allcause mortality, and length of stay (LOS). Propensity score weighting for these outcomes was performed using demographics, laboratory and clinical variables, and left ventricular ejection fraction (LVEF) as covariates. TTE parameters from presentation were also evaluated to determine if any had prognostic implications.Results: A total of 1,655 patients were included (101 patients with positive urine methamphetamine and 1,554 patients without). Patients with MethHF were younger, more likely to be male, had fewer comorbidities, had lower LVEF, and were more likely to have right ven-tricular systolic dysfunction. In propensity-weighted analyses, there were no significant differences in LOS, 30-day composite outcome, or 365-day mortality between the MethHF and non-MethHF group in (P > 0.05 for all). Presence of at least moderate tricuspid valve regurgitation (TR) was the only TTE predictor of 30-day composite outcome (odds ratio (OR) = 4.67, 95% confidence interval (CI): 1.5 -14.50, P < 0.01) and 365-day mortality (OR = 4.67, 95% CI: 1.5 -14.50, P < 0.01) in the MethHF group. Conclusion:Patients with MethHF admitted for decompensated HF had similar outcomes compared to non-MethHF after adjusting for baseline characteristics. TR is the only TTE value to predict outcomes in this population.

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Section: Discussionmentioning

confidence: 63%

Echocardiographic Parameters and Outcomes in Methamphetamine-Associated Heart Failure: A Propensity Score-Weighted Analysis

et al. 2022

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“…In this sense, an increase in the number of FMHF classes during hospitalization for worsening HF may be associated with better prognosis. However, although previous studies have demonstrated that a higher number of FMHF classes prescribed at the time of discharge is associated with better post-discharge prognosis 13 , 14 , no study has evaluated the association between changes in the number of FMHF classes and prognosis in patients requiring hospitalization for worsening HF.…”

Section: Introductionmentioning

confidence: 99%

Association between class of foundational medication for heart failure and prognosis in heart failure with reduced/mildly reduced ejection fraction

Ito

Maeda

Matsue

et al. 2022

Sci Rep

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We clarified the association between changes in the number of foundational medications for heart failure (FMHF) during hospitalization for worsening heart failure (HF) and post-discharge prognosis. We retrospectively analyzed a combined dataset from three large-scale registries of hospitalized patients with HF in Japan (NARA-HF, WET-HF, and REALITY-AHF) and patients diagnosed with HF with reduced or mildly reduced left ventricular ejection fraction (HFr/mrEF) before admission. Patients were stratified by changes in the number of prescribed FMHF classes from admission to discharge: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor blockers. Primary endpoint was the combined endpoint of HF rehospitalization and all-cause death within 1 year of discharge. The cohort comprised 1113 patients, and 482 combined endpoints were observed. Overall, FMHF prescriptions increased in 413 (37.1%) patients (increased group), remained unchanged in 607 (54.5%) (unchanged group), and decreased in 93 (8.4%) (decreased group) at discharge compared with that during admission. In the multivariable analysis, the increased group had a significantly lower incidence of the primary endpoint than the unchanged group (hazard ratio 0.56, 95% confidence interval 0.45–0.60; P < 0.001). In conclusion, increase in FMHF classes during HF hospitalization is associated with a better prognosis in patients with HFr/mrEF.

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“…33 In the clinical setting, implementation of HF treatment is not consistent with current guidelines (Figure 6). 24,[34][35][36][37] The new ACC/AHA/HFSA guidelines call for better incorporation of and devotion to social health determinants for vulnerable patient populations at risk for health disparities. Multidisciplinary management strategies should target both known risks for CVD and social determinants of health to level the playing field and address disparate outcomes in HF.…”

Section: Guideline-directed Medical Therapy and Individualized Strate...mentioning

confidence: 99%

“…FIGURE 6. GDMT Is Not Often the Clinical Reality in Patients With HFrEF24,[34][35][36][37] GDMT, guideline-directed medical therapy; HF, heart failure; HFrEF, heart failure with reduced ejection fraction.THE AMERICAN JOURNAL OF MANAGED CARE® Supplement VOL. 28, NO.…”

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confidence: 99%

Rethinking Heart Failure: Patient Classification and Treatment

Clark¹,

Desai

Owens³

et al. 2022

Am J Manag Care

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Role of Guideline Directed Medical Therapy Doses and Optimization in Patients Hospitalized With Decompensated Systolic Heart Failure

Cited by 10 publications

References 17 publications

Echocardiographic Parameters and Outcomes in Methamphetamine-Associated Heart Failure: A Propensity Score-Weighted Analysis

Echocardiographic Parameters and Outcomes in Methamphetamine-Associated Heart Failure: A Propensity Score-Weighted Analysis

Association between class of foundational medication for heart failure and prognosis in heart failure with reduced/mildly reduced ejection fraction

Rethinking Heart Failure: Patient Classification and Treatment

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