The Prescription Pattern of Heart Failure Medications in Reduced, Mildly Reduced, and Preserved Ejection Fractions

Rastogi, Tripti; Duarte, Kévin; Huttin, Olivier; Roubille, François; Girerd, Nicolas

doi:10.3390/jcm12010099

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…in those patients ( 13 , 28 ). This is supported by recent observational and clinical trial data indicating their broad uptake in patients discharged with HFmrEF/HFpEF ( 29 , 30 ). In the present study, prescription rates of beta-blockers and MRA at discharge in patients with HFmrEF/HFpEF were lower (29.8% and 34.0%, respectively) compared with patients without pneumonia (49.4% and 45.8%, respectively) and the development of pneumonia was independently associated with a lower likelihood of providing beta-blockers and MRA at discharge in patients with HFmrEF/HFpEF.…”

Section: Discussionsupporting

confidence: 64%

“…There was no difference in the prescription of ACEI/ARB/ARNI and SGLT2I. Overall prescription of SGLT2I in patients with HFmrEF/ HFpEF was higher than in some of the contemporary studies (29,30). This may reflect the high prevalence of concomitant T2DM, but also greater confidence among the treating physicians regarding the safety of SGLT2I initiation early after stabilisation in AHF.…”

Section: Discussionmentioning

confidence: 72%

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Predictors and prognostic implications of hospital-acquired pneumonia in patients admitted for acute heart failure

Polovina,

Tomić,

Viduljević

et al. 2023

Front. Cardiovasc. Med.

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IntroductionData on predictors and prognosis of hospital acquired pneumonia (HAP) in patients admitted for acute heart failure (AHF) to intensive care units (ICU) are scarce. Better knowledge of these factors may inform management strategies. This study aimed to assess the incidence and predictors of HAP and its impact on management and outcomes in patients hospitalised for AHF in the ICU.Methodsthis was a retrospective single-centre observational study. Patient-level and outcome data were collected from an anonymized registry-based dataset. Primary outcome was in-hospital all-cause mortality and secondary outcomes included length of stay (LOS), requirement for inotropic/ventilatory support, and prescription patterns of heart failure (HF) drug classes at discharge.ResultsOf 638 patients with AHF (mean age, 71.6 ± 12.7 years, 61.9% male), HAP occurred in 137 (21.5%). In multivariable analysis, HAP was predicted by de novo AHF, higher NT proB-type natriuretic peptide levels, pleural effusion on chest x-ray, mitral regurgitation, and a history of stroke, diabetes, and chronic kidney disease. Patients with HAP had a longer LOS, and a greater likelihood of requiring inotropes (adjusted odds ratio, OR, 2.31, 95% confidence interval, CI, 2.16–2.81; p < 0.001) or ventilatory support (adjusted OR 2.11, 95%CI, 1.76–2.79, p < 0.001). After adjusting for age, sex and clinical covariates, all-cause in-hospital mortality was significantly higher in patients with HAP (hazard ratio, 2.10; 95%CI, 1.71–2.84; p < 0.001). Patients recovering from HAP were less likely to receive HF medications at discharge.DiscussionHAP is frequent in AHF patients in the ICU setting and more prevalent in individuals with de novo AHF, mitral regurgitation, higher burden of comorbidities, and more severe congestion. HAP confers a greater risk of complications and in-hospital mortality, and a lower likelihood of receiving evidence-based HF medications at discharge.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 72%

Predictors and prognostic implications of hospital-acquired pneumonia in patients admitted for acute heart failure

Polovina,

Tomić,

Viduljević

et al. 2023

Front. Cardiovasc. Med.

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“…A recent study performed in Spain and including patients with HFpEF up to 2019 found that 79.8% were taking RAAS inhibitors (12% sacubitril–valsartan), 65.9% were taking betablockers, 27.7% mineralocorticoid receptor antagonists and only 5.1% SGLT2i [ 1 ]. A study performed in France showed that 73.7% were taking RAAS inhibitors, 80.3% were taking betablockers, and 21.6% mineralocorticoid receptor antagonists [ 22 ]. Despite having improved the percentage of patients taking treatment recommended for HF compared with previous studies, there is still considerable room for improvement in the form of a more favorable prognosis and reduced risk of readmission with HF, especially when treatment is started early, including both before and after discharge, which is the most vulnerable period for affected patients [ 6 , 23–25 ].…”

Section: Discussionmentioning

confidence: 99%

Progress of patients hospitalized with acute heart failure treated with empagliflozin

Raya-Cruz,

Jurado,

de la Torre Peregrín

et al. 2024

J. Comp. Eff. Res.

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Aim: To describe the epidemiological, clinical and laboratory characteristics and clinical progress of patients hospitalized with heart failure (HF) who started treatment with empagliflozin before discharge. Methods: We performed a retrospective observational study of patients aged ≥18 years admitted to the Internal Medicine Department of University Hospital Jaen, Jaen, Spain with acute HF between 1 May 2022 and 31 May 2023. Patients had to have a life expectancy of ≥1 year and have started treatment with empagliflozin during admission. Results: We included 112 patients (mean age, 85.2 ± 6.5 years; 67.9% women; 35.7 and 31.3% in NYHA functional classes III and IV; 73.2% with HF and preserved ejection fraction). Before admission, 80.4% were taking loop diuretics, 70.6% renin–angiotensin–aldosterone system inhibitors, 49.1% betablockers and 25% mineralocorticoid receptor antagonists. At admission, 94.6% were taking furosemide (15.2% at high doses, 36.6% at intermediate doses). The dose of furosemide was reduced at initiation of empagliflozin. At the end of follow-up, 13.4% of patients had died, 93.8% of the survivors continued treatment with empagliflozin and 26.8% had attended the emergency department with signs and symptoms of HF. Conclusion: Introduction of empagliflozin before discharge from hospital in patients admitted with HF made it possible to reduce the dose of diuretics during admission. The frequency of complications was as expected, and treatment was largely maintained.

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“…), female sex, lower body habitus/body mass index (BMI), HR, SBP and serum potassium level. 18,26,47,[62][63][64][65][66] These parameters may be perceived as an individual's fragility, leading to either careful up-titration of GDMT or no intent at all. 25 Indeed, there was an independent association between obesity (BMI ≥30 kg/m 2 ) and likelihood of prescription/ up-titration to target doses of GDMT in the Swedish Heart Failure Registry.…”

Section: Factors Associated With Suboptimal Treatment: Potential Caus...mentioning

confidence: 99%

Optimization of GDMT for patients with heart failure and reduced ejection fraction: can physiological and biological barriers explain the gaps in adherence to heart failure guidelines?

Jarjour,

Ducharme

2023

DIC

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Heart failure is a growing epidemic with high mortality rates and recurrent hospital admissions that creates a burden on affected individuals, their caregivers and the whole healthcare system. Throughout the years, many randomized trials have established the effectiveness of several pharmacological therapies and electrophysiological devices to reduce hospitalizations and improve quality of life and survival, mostly for patients with heart failure with reduced ejection fraction (HFrEF). These studies led to the publication of national societies' recommendations to guide clinicians in the management of HFrEF. Yet, many reports have shown significant care gaps in adherence to these recommendations in clinical practice, highlighting suboptimal use and/or dosing of evidence-based therapies. Adherence to guidelines has been shown to be associated with the best prognosis in HFrEF, with patients presenting with intolerances or contraindications having the highest risk of events; however, it remains unclear whether this association is causal or merely a marker of more advanced disease. Furthermore, individual characteristics may limit the possibility of reaching the targeted dosage of specific agents. Herein, we provide a comprehensive overview of clinicians' adherence to heart failure guidelines in a specialized real-life setting, particularly regarding use and optimization of guideline-derived medical therapies, as well as the implementation of more recent agents such as sacubitril/valsartan and SGLT2 inhibitors. We seek potential explanations for suboptimal treatment and its impact on patient outcomes.

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The Prescription Pattern of Heart Failure Medications in Reduced, Mildly Reduced, and Preserved Ejection Fractions

Cited by 7 publications

References 27 publications

Predictors and prognostic implications of hospital-acquired pneumonia in patients admitted for acute heart failure

Predictors and prognostic implications of hospital-acquired pneumonia in patients admitted for acute heart failure

Progress of patients hospitalized with acute heart failure treated with empagliflozin

Optimization of GDMT for patients with heart failure and reduced ejection fraction: can physiological and biological barriers explain the gaps in adherence to heart failure guidelines?

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