Defining the gap in heart failure treatment in patients with cardiac implantable electronic devices

Salimian, Samaneh; Moghaddam, Nima; Deyell, Marc W.; Virani, Sean; Bennett, Matthew T.; Krahn, Andrew D.; Andrade, Jason G.; Hawkins, Nathaniel M.

doi:10.1007/s00392-022-02123-x

Cited by 3 publications

(6 citation statements)

References 34 publications

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“…Based on current evidence, about 40 % of CRT recipients are potentially indicated for medical therapy optimization with S/V and gliflozins 9,36,37 . Furthermore, it is essential to determine the effectiveness of ARNi and SGLT2i in patients with CIED and in particular CRT.…”

Section: Arni and Sglt2i Effectiveness In Long-term Follow-upmentioning

confidence: 99%

“…Furthermore, the cardiac resynchronization therapy (CRT) is an established treatment for therapy-refractory mild to severe HFrEF patients with left ventricular conduction delay and is recommended for symptomatic patients despite optimal medical therapy for at least 3 months 6 . The clinical benefit of ARNi and SGLT2i initiation is net in non-device-bearing patients 7,8 , however in large multicentric trials only a minority of patients were already implanted with a cardiac resynchronization therapy with defibrillator (CRTD), and in a real-world setting a significant gap in their prescription exists 9 . Thus, it is less clear whether CRTD carriers may further benefit of the treatment with ARNi and SGLT2i even when starting them after the device implantation.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Sacubitril/Valsartan and Gliflozins in Heart Failure with Reduced Ejection Fraction after Cardiac Resynchronization Therapy

Fonderico

Pergola

Faccenda

et al. 2023

Preprint

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BACKGROUND. The angiotensin receptor-neprilysin inhibitor (ARNi) and the sodium-glucose co-transporter 2 inhibitors (SGLT2i) have improved the outcome of patients with heart failure and reduced ejection fraction (HFrEF). However, data characterizing their effectiveness after cardiac resynchronization therapy (CRT) implant are relatively scarce. This study investigated the impact of ARNi and SGLT2i treatment 1) on CRT response at 12 months 2) on the cardiac function and the clinical functional status (NYHA class) at mid- and long-term follow-up 3) on the cardiac and overall survival at long-term follow-up. METHODS AND RESULTS. HFrEF patients referred for CRT implant were enrolled in the study and were grouped by the ARNi/SGLT2i therapy. The first analysis investigated the synergistic impact of these drugs started at implant on 1-year CRT response and included all 172 patients enrolled. In order to evaluate whether the time of ARNi/SGLT2i initiation after CRT response assessment is meaningful, the second analysis considered 100 patients with a follow-up > 24 months. The median follow-up was 63.1 (confidence interval [CI] 95%, 52.7 - 73.8) months. At 1-year follow-up, 40 of 51 (78.4%) patients in ARNi or SGLT2i group and 66 of 121 (54.5%) in the no treatment group were classified as responders (p = 0.006). In multivariable analysis, ARNi/SGLT2i use was an independent predictor of CRT response (odds ratio, 5.38; CI 95%, 2-16.2; p = 0.001). At mid-term follow-up (median time [interquartile range, IQR] 40.6 [25.2; 58.3] months), 61 patients started to assume these drugs. NYHA functional class improved in 23 (37.7%) patients and decreased in only 2 (3.3%) in ARNi/SGLT2i patients vs 13 (33.3%) in no treatment group (p < 0.001). ARNi and SGLT2i improved significantly also the ? LVEF, with a median [IQR] increase of 4 [2; 8] % compared to the no treatment group -1.8 [-4; 0.2] % (p < 0.001) and were independently associated with a NYHA functional class II or I at long-term (hazard ratio [HR], 3.67; CI 95%, 1.37-10.2; p < 0.001). Their estimated effectiveness was consistent over the entire follow-up period (Schoenfeld residuals test, p = 0.10), although without reaching statistical significance effects on cardiovascular survival (HR, 0.61; CI 95%, 0.25-1.50; p = 0.22). CONCLUSIONS. The ARNi and SGLT2i treatment in CRT patients improves the clinical and echocardiographic response at 12-month and long-term follow-up, independently from the time of initiation. These drugs also confer benefit on survival, however further studies are needed to confirm these data.

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Section: Arni and Sglt2i Effectiveness In Long-term Follow-upmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Role of Sacubitril/Valsartan and Gliflozins in Heart Failure with Reduced Ejection Fraction after Cardiac Resynchronization Therapy

Fonderico

Pergola

Faccenda

et al. 2023

Preprint

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“… 1 In our previous study, we assessed the eligibility, uptake, dose, and contraindications to GDMT in patients with HFrEF and an ICD or CRT in 2 device clinics in Vancouver, Canada (preintervention cohort). 2 Optimization of GDMT by electrophysiologists during device clinic visits was also evaluated. Despite broad eligibility for quadruple therapy including newer medications such as angiotensin receptor–neprilysin inhibitors (ARNIs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors, uptake was lower than expected.…”

Section: Introductionmentioning

confidence: 99%

“…Despite broad eligibility for quadruple therapy including newer medications such as angiotensin receptor–neprilysin inhibitors (ARNIs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors, uptake was lower than expected. 2 More than half of patients were not prescribed target doses of quadruple therapy, and initiation and dose optimization was uncommon. Notably, in almost half of patients, optimization was deferred to other specialists (20%) or was not mentioned at all (25%).…”

Section: Introductionmentioning

confidence: 99%

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Quality improvement initiative to optimize heart failure treatment in patients with cardiac implantable electronic devices

Salimian¹,

Deyell²,

Bennett³

et al. 2023

Heart Rhythm O2

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Impact of sacubitril/valsartan and gliflozins on cardiac resynchronization therapy response in ischemic and non-ischemic heart failure patients

Fonderico,

Pergola,

Faccenda

et al. 2023

International Journal of Cardiology

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Defining the gap in heart failure treatment in patients with cardiac implantable electronic devices

Cited by 3 publications

References 34 publications

The Role of Sacubitril/Valsartan and Gliflozins in Heart Failure with Reduced Ejection Fraction after Cardiac Resynchronization Therapy

The Role of Sacubitril/Valsartan and Gliflozins in Heart Failure with Reduced Ejection Fraction after Cardiac Resynchronization Therapy

Quality improvement initiative to optimize heart failure treatment in patients with cardiac implantable electronic devices

Impact of sacubitril/valsartan and gliflozins on cardiac resynchronization therapy response in ischemic and non-ischemic heart failure patients

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