Therapeutic inertia in the pharmacological management of heart failure with reduced ejection fraction

Girerd, Nicolas; Hunolstein, Jean-Jacques Von; Pellicori, Pierpaolo; Bayés‐Genís, Antoni; Jaarsma, Tiny; Lund, Lars H.; Boivin, Jean‐Marc; Chouihed, Tahar; Costa, J.; Eicher, Jean‐Christophe; Estelle, F.; Kénizou, David; Maillier, B; Nazeyrollas, Pierre; Roul, G.; Zannad, N.; Rossignol, Patrick; Seronde, Marie‐France

doi:10.1002/ehf2.13929

Cited by 29 publications

(35 citation statements)

References 44 publications

(89 reference statements)

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“…Therefore, most patients with HF should be treated with SGLT2i. However, considering the therapeutic inertia observed in HF over the past decades [45], the issue of the actual implementation of SGLT2i in routine practice remains a source of concern. Given the multiplicity of currently available HF drugs, the best healthcare organization to achieve effective HF treatment is of paramount importance.…”

Section: Discussionmentioning

confidence: 99%

“…Although challenging to apply, polypharmacy is likely to be the most reasonable approach to the treatment of patients with HF, and the use of SGLT2i is expected to be the easiest to implement. Yet, to favour the implementation of all four drugs and fight therapeutic inertia, it seems reasonable to empower dedicated healthcare organizations’ strategies to develop a global response to fight therapeutic inertia, which has been reviewed elsewhere [45]. Briefly, disease management programmes, usually heavily relying on HF nurses, HF clinics and multidisciplinary HF team management for hospitalized patients, are among the solutions that could strongly favour the implementation of HF drugs, including SGLT2i [45].…”

Section: Patients With Hf Eligible For Sglt2i Therapymentioning

confidence: 99%

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SGLT2 inhibition in heart failure with reduced or preserved ejection fraction: Finding the right patients to treat

Girerd

Zannad

2023

J Intern Med

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Section: Discussionmentioning

confidence: 99%

Section: Patients With Hf Eligible For Sglt2i Therapymentioning

confidence: 99%

SGLT2 inhibition in heart failure with reduced or preserved ejection fraction: Finding the right patients to treat

Girerd

Zannad

2023

J Intern Med

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“…However, more careful management of these patients could reduce these potential obstacles. As a result, improving the transition of care, a higher use of HF clinics, the development of ambulatory disease management programs, enhancing the role of HF nurses, and a higher empowerment of patients and their families could be very helpful to reduce therapeutic inertia, leading to a better prescription of HF drugs [ 41 ]. Fortunately, our data showed that, despite patients in the 2019 cohort being older and having some more comorbidities than 2016 patients, HF treatment was more optimized.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain

Cervantes

Palacios

Varela

et al. 2022

JCM

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Objective: To estimate the prevalence, incidence, and describe the characteristics and management of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods: Adults with ≥1 inpatient or outpatient HF diagnosis between 1 January 2013 and 30 September 2019 were identified through the BIG-PAC database. Annual incidence and prevalence by EF phenotype were estimated. Characteristics by EF phenotype were described in the 2016 and 2019 HF prevalent cohorts and outcomes in the 2016 HF prevalent cohort. Results: Overall, HF incidence and prevalence were 0.32/100 person-years and 2.34%, respectively, but increased every year. In 2019, 49.3% had HFrEF, 38.1% had HFpEF, and 4.3% had HFmrEF (in 8.3%, EF was not available). Compared with HFrEF, patients with HFpEF were largely female, older, and had more atrial fibrillation but less atherosclerotic cardiovascular disease. Among patients with HFrEF, 76.3% were taking renin-angiotensin system inhibitors, 69.5% beta-blockers, 36.8% aldosterone antagonists, 12.5% sacubitril/valsartan and 6.7% SGLT2 inhibitors. Patients with HFpEF and HFmrEF took fewer HF drugs compared to HFrEF. Overall, the event rates of HF hospitalization were 231.6/1000 person-years, which is more common in HFrEF patients. No clinically relevant differences were found in patients with HFpEF, regardless EF (50- < 60% vs. ≥60%). Conclusions: >2% of patients have HF, of which around 50% have HFrEF and 40% have HFpEF. The prevalence of HF is increasing over time. Clinical characteristics by EF phenotype are consistent with previous studies. The risk of outcomes, particularly HF hospitalization, remains high, likely related to insufficient HF treatment.

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“…After an acute HF decompensation, which can be either in an outpatient or in patient setting (ie, hospitalization, emergency department, outpatient clinic/day hospital), the patient pathway can be very heterogenous, as it currently depends on the specialist that treat the patient and also the specific health-care system in which the patient is attended. [15][16][17] Consequently, it is necessary to homogenize the management of these patients. The main components of the health-care organization among patients with WHF should include all settings in which the patients can be assisted (ie, hospitalization, emergency department, day hospital, office clinic), in order to optimize the management of the patient flow.…”

Section: Patient Pathway and Health Care Transitionmentioning

confidence: 99%

Optimization of Patient Pathway in Heart Failure with Reduced Ejection Fraction and Worsening Heart Failure. Role of Vericiguat

González-Juanàtey¹,

Comín‐Colet²,

Pascual-Figal³

et al. 2023

PPA

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Heart failure (HF) is a progressive condition with periods of apparent stability and repeated worsening HF events. Over time, unless optimization of HF treatment, worsening HF events become more frequent and patients enter into a cycle of recurrent events with high morbidity and mortality. In patients with HF there is an activation of deleterious neurohormonal pathways, such as the renin angiotensin aldosterone system and the sympathetic system, and an inhibition of protective pathways, including natriuretic peptides and guanylate cyclase. Therefore, HF burden can be reduced only through a holistic approach that targets all neurohormonal systems. In this context, vericiguat may play a key role, as it is the only HF drug that activates the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate system. On the other hand, it has been described relevant disparities in the management of HF population. Consequently, it is necessary to homogenize the management of these patients, through an integrated patient-care pathway that should be adapted at the local level. In this context, the development of new technologies (ie, video call, specific platforms, remote control devices, etc.) may be very helpful. In this manuscript, a multidisciplinary group of experts analyzed the current evidence and shared their own experience to provide some recommendations about the therapeutic optimization of patients with recent worsening HF, with a particular focus on vericiguat, and also about how the integrated patient-care pathway should be performed.

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Therapeutic inertia in the pharmacological management of heart failure with reduced ejection fraction

Cited by 29 publications

References 44 publications

SGLT2 inhibition in heart failure with reduced or preserved ejection fraction: Finding the right patients to treat

SGLT2 inhibition in heart failure with reduced or preserved ejection fraction: Finding the right patients to treat

Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain

Optimization of Patient Pathway in Heart Failure with Reduced Ejection Fraction and Worsening Heart Failure. Role of Vericiguat

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