2019
DOI: 10.1016/j.ijcha.2018.10.003
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Evaluation of a guideline directed medical therapy titration program in patients with heart failure with reduced ejection fraction

Abstract: IntroductionHeart failure is associated with recurrent hospitalizations and high mortality. Guideline directed medical treatment (GDMT), including beta blockers (BBs), angiotensin converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs) and aldosterone antagonists (AAs) has shown to improve outcomes. Current guidelines recommend the use of these medication classes at maximally tolerated dosages. Despite the evidence, < 25% of patients with heart failure with reduced left ventricular ejection… Show more

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Cited by 19 publications
(21 citation statements)
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“…Despite the anticipated increase, our data shows the rates of hospitalizations for CHF have not increased and in fact, appeared to decrease over a six-year span. This may be attributed to improved outpatient management of heart failure, optimization of guideline-directed medical therapy, as well as the focus by CMS to decrease 30 readmissions [14]. Our data suggests, however, that this improvement in outpatient management and benefit from primary care may not be ubiquitous amongst the population.…”
Section: Discussionmentioning
confidence: 75%
“…Despite the anticipated increase, our data shows the rates of hospitalizations for CHF have not increased and in fact, appeared to decrease over a six-year span. This may be attributed to improved outpatient management of heart failure, optimization of guideline-directed medical therapy, as well as the focus by CMS to decrease 30 readmissions [14]. Our data suggests, however, that this improvement in outpatient management and benefit from primary care may not be ubiquitous amongst the population.…”
Section: Discussionmentioning
confidence: 75%
“…dence-based doses, which was consistent with other studies. 14,15 The current study assessed different predictors for prescription of GDMT; neither age, gender, cardiovascular risk factors nor blood pressure can predict prescription of GDMT in HF, apart from higher pulse rate that increases prescription of -blockers. The main predictors reported in other studies for GDMT prescription were absence of chronic kidney diseases and presence of non-sustained VT, 13 while the main reported predictors for underutilization of GDMT in HF were older age group, frail patients with multiple comorbidities fearing from side effects of drugs, higher renal indices, hyperkalaemia, lower body weight and patient non-compliance; all contributed to under-prescription of GDMT.…”
Section: Discussionmentioning
confidence: 98%
“…Guideline-directed medical therapy (GDMT), such as bblockers, ACEIs, and ARBs, has improved the management and clinical outcomes of patients with HF and those with CKD over the past few decades. 65,66 However, the management of CRAS is complicated and lacks specific recommendations that take into account progressively deteriorating kidney function, different stages of HF, and the presence/absence of diabetes, hypertension, and other comorbidities. The clinical manifestation of CRAS is a combination of these factors and may require different approaches in individual patients as well as frequent medication changes that may deviate from GDMT.…”
Section: The Management Of Patients With Crsmentioning
confidence: 99%