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

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

doi:10.1002/clc.22375

Cited by 16 publications

(19 citation statements)

References 31 publications

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“…These findings are similar to those of the VIDA-IC study, in which MRAs were prescribed more frequently to patients with a reduced EF, with less consideration of symptom severity. This is possibly because LVEF is a less subjective measure than symptomatic classification [26]. The data from these two studies highlight that there is a significant proportion of HF patients with mild symptoms that may benefit from pharmacological treatment.…”

Section: Reflect-hf (Germany)mentioning

confidence: 86%

“…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%

“…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]. Taking into account the updated ESC guidelines, which recommend an MRA for patients with NYHA symptoms of II and above and LVEF \ 35 %, almost 56 % of the HF-REF patients with NYHA class II symptoms included in the registry would have been eligible for treatment with an MRA, but did not receive one [1].…”

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: Reflect-hf (Germany)mentioning

confidence: 86%

Section: Reflect-hf (Germany)mentioning

confidence: 99%

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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“…Pharmacotherapy according to the guidelines decreases morbidity and mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and may improve their quality of life. However, in daily practice this effect often cannot be achieved . Important reasons include medication non‐adherence and other drug‐related problems (DRPs).…”

Section: Introductionmentioning

confidence: 99%

PHARMacy‐based interdisciplinary program for patients with Chronic Heart Failure (PHARM‐CHF): rationale and design of a randomized controlled trial, and results of the pilot study

Laufs

Griese‐Mammen

Krueger

et al. 2018

European J of Heart Fail

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We report the rationale and design of a community PHARMacy-based prospective randomized controlled interdisciplinary study for ambulatory patients with Chronic Heart Failure (PHARM-CHF) and results of its pilot study. The pilot study randomized 50 patients to a pharmacy-based intervention or usual care for 12 months. It demonstrated the feasibility of the design and showed reduced systolic blood pressure in the intervention group as indicator for improved medication adherence. The main study will randomize patients ≥60 years on stable pharmacotherapy including at least one diuretic and a history of heart failure hospitalization within 12 months. The intervention group will receive a medication review at baseline followed by regular dose dispensing of the medication, counselling regarding medication use and symptoms of heart failure. The control patients are unknown to the pharmacy and receive usual care. The primary efficacy endpoint is medication adherence, pre-specified as a significant difference of the proportion of days covered between the intervention and control group within 365 days following randomization using pharmacy claims data for three CHF medications (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists). The primary composite safety endpoint is days lost due to blindly adjudicated unplanned cardiovascular hospitalizations or death. Overall, 248 patients shall be randomized. The minimum follow-up is 12 months with an expected mean of 24 months. Based on the feasibility demonstrated in the pilot study, the randomized PHARM-CHF trial will test whether an interdisciplinary pharmacy-based intervention can safely improve medication adherence and will estimate the potential impact on clinical endpoints. ClinicalTrials.gov Identifier: NCT01692119.

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“…[13][14][15] On the basis of these studies, ACEI are given the highest level of evidence in HF clinical guidelines, 11,12 with recent registries and real-world studies reporting prescription rates >90 % for ACEI/ARB therapy in eligible patients with HF. 16,17 …”

Section: Evidence For Angiotensin-converting Enzyme Inhibitors In Heamentioning

confidence: 99%

Should Angiotensin Receptor Neprilysin Inhibitors Replace Angiotensin-converting Enzyme Inhibitors in Heart Failure With a Reduced Ejection Fraction?

Hayman

Atherton

2016

Cardiac Failure Review

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Heart failure (HF) is associated with significant morbidity and mortality and confers a major economic burden.1 Large randomised controlled trials (RCTs) have demonstrated that inhibition of the renin-angiotensinaldosterone and sympathetic nervous systems improve outcomes in patients with HF and a reduced left ventricular ejection fraction (HFrEF) (see Figure 1), [2][3][4][5][6][7][8][9] with clinical guidelines recommending angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers and mineralocorticoid receptor antagonists in all patients with symptomatic HFrEF unless contraindicated. [10][11][12] However, despite the considerable therapeutic gains made in the field of HFrEF, outcomes remain poor especially in patients with persisting left ventricular systolic dysfunction. Evidence for Angiotensin-converting Enzyme Inhibitors in Heart FailureThe ACEIs was the first class of drug shown to improve survival rates and reduce HF hospitalisation rates in patients with mild, moderate or severely symptomatic HF.2,3 A meta-analysis of RCTs evaluating ACEI in patients with HF reported substantial reductions in total mortality rates (hazard ratio 13-15 On the basis of these studies, ACEI are given the highest level of evidence in HF clinical guidelines, 11,12 with recent registries and real-world studies reporting prescription rates >90 % for ACEI/ARB therapy in eligible patients with HF. 16,17 Rationale for Neprilysin Inhibition in Heart FailureNeprilysin is an enzyme that catalyses the degradation of a number of vasoactive compounds, including natriuretic peptides. Natriuretic peptides have multiple actions that could have a favourable effect on HF disease progression including vasodilation, natriuresis and diuresis;18 thus the promotion of natriuretic peptides through exogenous administration or inhibition of neprilysin are attractive therapeutic options. Intravenous nesiritide, a synthetic B-type natriuretic peptide (BNP), was shown to reduce the rates of dyspnoea and pulmonary capillary wedge pressure compared with placebo in the Vasodilation in the Management of Acute Congestive HF (VMAC) study; however, there was no difference in symptom improvement compared with nitroglycerin.19 Furthermore, nesiritide had no effect on death or rehospitalisation rates in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) study, and is therefore not recommended for routine use. 20The first orally available neprilysin inhibitor, candoxatril, although displaying a dose-dependent increase in atrial natriuretic peptide levels accompanied by natriuresis and haemodynamic benefits in the setting of HF in short-term studies, 21,22 was associated with increases in levels of angiotensin II and endothelin, which likely offsets the favourable haemodynamic effects in the absence of renin-angiotensin system inhibition. 23,24 Another neprilysin inhibitor, ecadotril, failed to show benefit in a dose-ranging study with a trend towards increased mortality rates. KeywordsAngiotensin-converting en...

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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

Cited by 16 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

PHARMacy‐based interdisciplinary program for patients with Chronic Heart Failure (PHARM‐CHF): rationale and design of a randomized controlled trial, and results of the pilot study

Should Angiotensin Receptor Neprilysin Inhibitors Replace Angiotensin-converting Enzyme Inhibitors in Heart Failure With a Reduced Ejection Fraction?

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