Guideline‐Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure

Tran, Richard; Aldemerdash, Ahmed; Chang, Patricia; Sueta, Carla A.; Kaufman, Brystana G.; Asafu‐Adjei, Josephine; Vardeny, Orly; Daubert, Eliza; Alburikan, Khalid A.; Kucharska‐Newton, Anna; Stearns, Sally C.; Rodgers, Jo E.

doi:10.1002/phar.2091

Cited by 59 publications

(57 citation statements)

References 28 publications

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“…18 Uptitration of GDMT in patients with heart failure with reduced ejection fraction is associated with a decreased risk of mortality, while discontinuation is associated with an increased risk of mortality. 19 However, recent registry data indicate that intensity of GDMT is just as likely to be decreased as increased during the hospitalization. 20 Nevertheless, predischarge initiation of medications may be associated with higher attained doses in follow-up.…”

Section: During Hospitalizationmentioning

confidence: 99%

The Role of Process Improvements in Reducing Heart Failure Readmissions

Dong¹

2020

JCOM

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Objective: To review selected process-of-care interventions that can be applied both during the hospitalization and during the transitional care period to help address the persistent challenge of heart failure readmissions. Methods: Review of the literature. Results: Process-of-care interventions that can be implemented to reduce readmissions of heart failure patients include: accurately identifying heart failure patients; providing disease education; titrating guideline-directed medical therapy; ensuring discharge readiness; arranging close discharge follow-up; identifying and addressing social barriers; following up by telephone; using home health; and addressing comorbidities. Importantly, the heart failure hospitalization is an opportunity to set up outpatient success, and setting up feedback loops can aid in postdischarge monitoring. Conclusion: We encourage teams to consider local capabilities when selecting processes to improve; begin by improving something small to build capacity and team morale, and continually iterate and reexamine processes, as health care systems are continually evolving.

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Section: During Hospitalizationmentioning

confidence: 99%

The Role of Process Improvements in Reducing Heart Failure Readmissions

Dong¹

2020

JCOM

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“…Эффек тивность депрескрайбинга оценивалась по следующим конечным точкам: первичные -прекращение участия в исследовании, изменение продолжительности физиче ской нагрузки по сравнению с исходным уровнем, вто ричные -ФК по New York Heart Association (NYHA), ка чество жизни, симптомы застойной СН и отказ от тера пии ЛС или плацебо изза ухудшения симптомов СН [10]. Безопасность депрескрайбинга оценивали с помощью электрокардиографии, рентгенографии органов грудной клетки, измерения АД, ЧСС, анализа ряда лабораторных показателей [35].…”

Section: ингибиторы апфunclassified

“…Выводы из анализа имеющихся литературных дан ных по депрескрайбингу ряда ЛС при СНнФВ соответ ствуют данным, опубликованным R. H. Tran с соавт. [35]. Авторы проанализировали результаты 5091 госпитали зации больных, наблюдающихся в рамках исследования ARIC (The Atherosclerosis Risk in Communities).…”

Section: дигоксинunclassified

“…Терапия была охарактеризована следующим образом по отношению к режиму приема / отмены ЛС и клиниче ским рекомендациям [35]: (1) «продолжение приема», если ЛС назначались в любой дозе и при выписке, и до го спитализации, либо до развития острой декомпенсиро ванной СН в стационаре, (2) «инициация» -назначение ЛС только в момент выписки, (3) «отмена» -назначение при поступлении и отмена при выписке, (4) «отсутствие терапии», если представитель группы ЛС не назначался ни при поступлении, ни при выписке [35]. Все случаи го спитализации были далее классифицированы как СНнФВ и СНсФВ (ФВ ЛЖ <50 % или ≥50 %, соответственно) или на случаи госпитализации с неизвестной ФВ ЛЖ.…”

Section: дигоксинunclassified

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Treatment of chronic heart failure: is deprescribing possible?

et al. 2020

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Лечение хронической сердечной недостаточности: возможен ли депрескрайбинг? Депрескрайбинг-это практика запланированной отмены, снижения дозы или замены лекарственного средства на более безопасное. В лечении хронической сердечной недостаточности (ХСН) используются одновременно несколько групп лекарственных средств (ЛС), что повышает риск развития нежелательных лекарственных реакций, особенно у пациентов пожилого и старческого возраста. В результате систематического поиска и анализа литературы была оценена возможность депрескрайбинга следующих лекарственных групп: 1) ЛС, влияющие на ренин-ангиотензин-альдостероновую систему, 2) бета-блокаторы, 3) дигоксин, 4) диуретики. Были проанализированы 3 систематических обзора и ряд исследований для определения наиболее возможных и потенциально оптимальных режимов депрескрайбинга при ХСН. Определено, что депрескрайбинг при ХСН имеет крайне ограниченный потенциал применения из-за доказанного очевидного влияния ряда групп ЛС на прогноз и выраженность клинической симптоматики у пациентов с ХСН. Ключевые слова Cердечная недостаточность, пожилой и старческий возраст, депрескрайбинг, полипрагмазия, ингибиторы ангиотензинпревращающего фермента, блокаторы рецепторов к ангиотензину II, бета-блокаторы, диуретики, дигоксин

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“…Effectiveness of beta blockers in patients of heart failure with these common co‐morbidities have not been discussed in the guidelines, and their use appears mere extrapolation of the data of the trials. The observational report of heart failure hospitalization in the ARIC cohort showed that, initiation of GDMT reduced mortality at 1 year, but 23% patients needed GDMT modification predicted by selected comorbidities and disease acuity …”

Section: Beta Blockers In Heart Failure Patients With Other Co‐morbidmentioning

confidence: 99%

GDMT for heart failure and the clinician's conundrum

Samarendra

2019

Clinical Cardiology

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Therapeutic advances in management of CHF have decreased mortality and have impacted progression in patients with mild to moderate heart failure. Aggressive campaigns by cardiology societies aimed at increasing implementation of these measures in routine practices have almost generalized the treatment of heart failure irrespective of individual variations of clinical status of patients and stages of heart failure. This explains why morbidity compression and quality of life improvement have not been realized fully particularly in patients with advanced disease. To examine whether GDMT for CHF is backed by unambiguous evidence of clinical efficacy for its global implementation in every patient at all stages of the syndrome. ACC/AHA, ESC Guidelines for CHF, and their updates were reviewed. Clinical trial cited in the guideline documents and other pertaining published literatures were analyzed.FindingsMany of the recommended GDMT for CHF lack unequivocal evidence of clinical efficacy in patients with diverge etiology of heart failure and concomitant comorbid conditions Some of the recommendations which are useful in early stages, lack evidence of efficacy in more advanced stages of heart failure. Application of results of research trials in patients beyond their inclusion and exclusion criteria, appears mere extrapolation, Clinicians are faced with the conundrum of implementing the recommendations without indubitable evidence of their efficacy in every patient of their practice.ConclusionA reappraisal of Guidelines is needed to address outstanding questions pertaining to the efficacy of recommendations and plug the knowledge gaps without assumption and extrapolation of results of RCTs beyond their inclusion and exclusion criteria.

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Guideline‐Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure

Abstract: Our study suggests that GDMT initiation is associated with increased survival, and discontinuation of therapy is associated with reduced survival in hospitalized patients with HF. Future studies should be conducted to confirm the impact of GDMT therapy modification in this population.

Cited by 59 publications

References 28 publications

The Role of Process Improvements in Reducing Heart Failure Readmissions

The Role of Process Improvements in Reducing Heart Failure Readmissions

Treatment of chronic heart failure: is deprescribing possible?

GDMT for heart failure and the clinician's conundrum

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