‘Time is prognosis’ in heart failure: time‐to‐treatment initiation as a modifiable risk factor

Abdin, Amr; Anker, Stefan D.; Butler, Javed; Coats, Andrew J.S.; Kindermann, Ingrid; Lainščak, Mitja; Lund, Lars H.; Metra, Marco; Mullens, Wilfried; Rosano, Giuseppe; Slawik, Jonathan; Wintrich, Jan; Böhm, Michael

doi:10.1002/ehf2.13646

Cited by 58 publications

(88 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…from 20–25% to 25–30%), suggesting an actual clinical benefit. Importantly, in our study, ARNI treatment was associated with improved LVEF when started 3 years or less from HF diagnosis, in concordance with previous reports of the safety and benefit of early commencement of ARNI therpay 17–20 . The differential LV remodelling response according to HF duration emphasizes the need for early ARNI initiation in HFrEF patients, a concept that have been implemented in recent clinical practice guidelines 21…”

Section: Discussionsupporting

confidence: 91%

“…Importantly, in our study, ARNI treatment was associated with improved LVEF when started 3 years or less from HF diagnosis, in concordance with previous reports of the safety and benefit of early commencement of ARNI therpay. [17][18][19][20] The differential LV remodelling response according to HF duration emphasizes the need for early ARNI initiation in HFrEF patients, a concept that have been implemented in recent clinical practice guidelines. 21 An important aspect of our work is the further analysis of subgroups, which exhibit more significant benefit from ARNI treatment, suggesting that reverse LV remodelling effect was more pronounced in selected patient populations.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy

et al. 2022

View full text Add to dashboard Cite

AimsTo assess the effect of angiotensin receptor blockers/neprilysin inhibitors (ARNI) on left ventricular (LV) ejection fraction (LVEF) and LV dimensions in a real-life cohort of heart failure and reduced ejection fraction (HFrEF) patients, while analysing patient characteristics that may predict reverse LV remodelling. Methods and resultsThe ARNI-treated HFrEF patients followed at a single tertiary medical centre HF-outpatient clinic were included in the study. Clinical and echocardiographic parameters were evaluated prior to ARNI initiation, and while on ARNI therapy, assessing patient characteristics associated with reverse LV remodelling. The cohort included 91 patients (mean age 60.5 years, 90% male) and 47 (52%) patients exhibited ARNI responsiveness, defined as an increase in LVEF during therapy. Overall, LVEF increased by 19% post-ARNI (23.8 to 28.4%, P < 0.001). Subgroup analysis revealed several parameters associated with significant LVEF improvement, including baseline LVEF <30%, non-ischaemic HF aetiology, lack of cardiac resynchronization therapy (CRT), better initial functional class and ARNI initiation within 3 years from HF diagnosis (P ≤ 0.001 for all). Significant reduction in LV dimensions was noted in patients with lower initial LVEF, non-ischaemic HF and no CRT. Further combined subgrouping of the study population demonstrated that patients with both LVEF <30% and a non-ischaemic HF gained most benefit from ARNI with an average of 51% improvement in LVEF (19.9 to 30%, P < 0.001). Conclusions The ARNI treatment response is not uniform among HFrEF patient subgroups. More pronounce reverse LV remodelling is associated with early ARNI treatment initiation in the course of HFrEF, and in those with LVEF <30%, non-ischaemic HF and no CRT.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Being able to accurately discern AHF from other etiologies of dyspnea and initiate disease-specific treatment in the prehospital setting is crucial as this has a direct impact on patient prognosis [14][15][16][17]. Increasingly "time to therapy" is thought to be of great benefit in patients with AHF, similar to patients with acute coronary syndrome [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…A large portion of patients (36/50, 72%) did not receive AHF therapies that were available to administer in the prehospital setting. This is of concern as we know earlier treatment is associated with improved outcomes [14][15][16], and delayed therapy is linked to higher mortality [17,22]. Four patients that did not have a prehospital diagnosis of AHF received nitroglycerin to treat chest pain.…”

Section: Discussionmentioning

confidence: 99%

Prehospital Diagnosis and Treatment of Patients With Acute Heart Failure

Supples¹,

Jelden²,

Pallansch³

et al. 2022

Cureus

View full text Add to dashboard Cite

Introduction Early diagnosis and optimization of heart failure therapies in patients with acute heart failure (AHF), including in the prehospital setting, is crucial to improving outcomes. However, making the diagnosis of AHF in the prehospital setting is difficult. The goal of this study was to evaluate the accuracy of prehospital diagnosis (AHF versus not heart failure [HF]) in patients with acute dyspnea when compared to final hospital diagnosis. Methods We conducted a retrospective study of adult patients transported by emergency medical services (EMS) with a primary or secondary complaint of shortness of breath. Patients were identified through an EMS electronic database (ESO) and matched to their hospital encounter. ESO was reviewed for prehospital diagnosis and management. Hospital electronic medical records were reviewed to determine final hospital diagnosis, management in the emergency department and hospital, disposition, and length of stay. The primary outcome compared prehospital diagnosis to final hospital diagnosis, which served as our criterion standard. Results Of 199 included patients, 50 (25%) had a final diagnosis of AHF. Prehospital paramedic sensitivity and accuracy for AHF were 14% (7/50; confidence interval [CI] 0.06-0.26) and 77% (CI 0.70-0.82), respectively. In the 50 patients with AHF, 14 (28%) received nitroglycerin in the prehospital setting, while 27 (54.0%) patients were inappropriately treated with albuterol. Conclusion Prehospital paramedics had poor sensitivity and moderate accuracy for the diagnosis of AHF. A small percentage of patients ultimately diagnosed with AHF had HF therapy initiated in the prehospital setting. This data highlights the fact that AHF is difficult to diagnose in the prehospital setting and is commonly missed.

show abstract

“…Furthermore, geriatric patients affected by HF often show an increased hospital admission or emergency department visits, due to worsening HF symptoms (24)(25)(26). Developing and intriguing research is looking for possible predictors of rehospitalization (24) and great importance is given to the "vulnerable time, " which immediately follows the discharge for acute HF (27).…”

Section: Introductionmentioning

confidence: 99%

Arterial Stiffness, Subendocardial Impairment, and 30-Day Readmission in Heart Failure Older Patients

Fantin

Giani

Franconi

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Arterial stiffness and subendocardial perfusion impairment may play a significant role in heart failure (HF) outcomes. The aim of the study was to examine the main predictors of 30-day readmission in geriatric patients, hospitalized with HF, explore hemodynamical parameters, arterial stiffness indexes, and subendocardial viability ratio (SEVR). In total, 41 hospitalized patients, affected by HF, were included; they underwent clinical evaluation, routine laboratory testing, and echocardiography. At the time of admission, after the achievement of clinical stability (defined as switching from intravenous to oral diuretic therapy), and at discharge, arterial tonometry was performed to evaluate carotid-femoral pulse wave velocity (PWVcf) and SEVR (then corrected for hemoglobin concentration and oxygen saturation). Through the evaluations, a significant progressive decrease in PWVcf was described (17.79 ± 4.49, 13.54 ± 4.54, and 9.94 ± 3.73 m/s), even after adjustment for age, gender, mean arterial pressure (MAP) variation, and left ventricular ejection fraction (LVEF). A significant improvement was registered for both SEVR (83.48 ± 24.43, 97.94 ± 26.84, and 113.29 ± 38.02) and corrected SEVR (12.74 ± 4.69, 15.71 ± 5.30, and 18.55 ± 6.66) values, and it was still significant when adjusted for age, gender, MAP variation, and LVEF. After discharge, 26.8% of patients were readmitted within 30 days. In a multivariate binary logistic regression analysis, PWVcf at discharge was the only predictor of 30-day readmission (odds ratio [OR] 1.957, 95% CI 1.112–3.443). In conclusion, medical therapy seems to improve arterial stiffness and subendocardial perfusion in geriatric patients hospitalized with heart failure. Furthermore, PWVcf is a valid predictor of 30-day readmission. Its feasibility in clinical practice may provide an instrument to detect patients with HF at high risk of rehospitalization.

show abstract

‘Time is prognosis’ in heart failure: time‐to‐treatment initiation as a modifiable risk factor

Cited by 58 publications

References 82 publications

Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy

Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy

Prehospital Diagnosis and Treatment of Patients With Acute Heart Failure

Arterial Stiffness, Subendocardial Impairment, and 30-Day Readmission in Heart Failure Older Patients

Contact Info

Product

Resources

About