In-Hospital Therapy for Heart Failure With Reduced Ejection Fraction in the United States

Greene, Stephen J.; Triana, Taylor; Ionescu‐Ittu, Raluca; Burne, Rebecca; Guérin, Annie; Borentain, Maria; Kessler, Paul D.; Tuğcu, Aylin; DeSouza, Mary M.; Felker, G. Michael; Chen, Lei

doi:10.1016/j.jchf.2020.05.013

Cited by 37 publications

(40 citation statements)

References 15 publications

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“…Consistent with previous Japanese research [10,11,13,18,[23][24][25], the present study shows that LOS is long for AHF hospitalizations in Japan (median of 17 days; mean 23 days) compared to Europe where registry-based studies showed a median AHF hospitalization LOS of 7 to 10 days [7] and to the US where a recent realworld study reported a median AHF hospitalization LOS of 4 days (mean of 6.6 days) [26]. This reveals that the duration of IV therapy in patients hospitalized for AHF in Japan (median 6 days; mean 10.6 days) is as long as or even longer than the duration of the full AHF hospitalization in Europe or the US.…”

Section: Discussionsupporting

confidence: 91%

Disease Management and Outcomes in Patients Hospitalized for Acute Heart Failure in Japan

et al. 2021

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Introduction: This study described patients hospitalized for acute heart failure (AHF) in Japan who received intravenous (IV) diuretics and/or vasodilators as the initial therapy. Methods: The Japan Medical Data Vision database was used to identify adult patients hospitalized for AHF during 2013-2017, who were hemodynamically stable at presentation and treated with IV diuretics and/or IV vasodilators as initial therapy. Treatment patterns and use of cardiac rehabilitation, as well as outcomes (e.g., length of stay [LOS], in-hospital mortality, HFreadmission) were reported overall and by year of AHF hospitalization.Results: Of 30,360 patients (mean age = 80.0 years; 52.2% male), 87.0% were treated during the hospitalization with IV diuretics, 63.9% with IV vasodilators, and 13.8% with intensified therapies. On average, the duration of IV therapy was 10.6 days. Inhospital cardiac rehabilitation was utilized by 51.7% of the patients for 11.7 days on average. Mean LOS was 23.3 days, while in-hospital mortality and 30-day HF readmission post-discharge were 13.2 and 9.5%, respectively. Hospitalization outcomes remained stable between 2013 and 2017 despite important changes in AHF management such as a decrease in carperitide use (55.9-40.0% in 2017), and increases in use of tolvaptan (from 14.2% in 2013 to 31.3% in 2017) and of cardiac rehabilitation (from 43.2% in 2013 to 56.1% in 2017). Patients with intensified therapies had the longest IV therapy duration (mean 23.8 days vs. 5.5-9.9 days), the highest cardiac rehabilitation services use (60.2 vs. 38.3-57.0%), the longest LOS (mean 36.7 vs. 16.3-22.2 days), and the highest in-hospital mortality (37.4 vs. 3.1-12.4%) compared to the other treatment groups. Conclusions: Contemporary treatment for AHF hospitalization in Japan comprises a long duration of IV therapy followed by extended use of oral medications and in-hospital cardiac rehabilitation prior to discharge. Patients requiring intensified therapies had much longer LOS and higher in-hospital mortality.

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Section: Discussionsupporting

confidence: 91%

Disease Management and Outcomes in Patients Hospitalized for Acute Heart Failure in Japan

et al. 2021

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“…Although we have no data on the dose of intravenous furosemide and are unable to examine an association of up-titration of loop diuretics and add-on tolvaptan with patient outcomes, results from our study and the previous study 5 seem to show that physicians in Japan preferentially implement the initial sequential nephron blockade strategy with tolvaptan relative to up-titration of loop diuretics in clinical practice. In the United States, however, one fifth to one third of inpatients with HF had in-hospital treatment escalated beyond initial intravenous diuretic therapy (i.e., up-titration of intravenous diuretics) 15 , while 30–40% of AHF patients in Japan added tolvaptan into intravenous furosemide, reflecting a possibility that the initial dose of loop diuretics for AHF patients may not be sufficient in Japan. Future research is warranted to revalidate the position of 2nd-line diuretics, such as tolvaptan and thiazide-type diuretics, in the treatment for HF and identify patients who can benefit from tolvaptan, given that no clear recommendation with robust clinical evidence to the best diuretic regimen for diuretic-resistant cases.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends in tolvaptan use after revision of national heart failure guidelines in Japan

Yamazaki

Kohsaka

Nagatomo

et al. 2021

Sci Rep

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Within no definite diuretic protocol for acute heart failure (AHF) patients and its variation in regional clinical guidelines, the latest national guidelines in Japan commends use of tolvaptan in diuretic-resistant patients. This study aimed to examine trends in tolvaptan usage and associated outcomes of AHF patients requiring hospitalization. Between April, 2018 and October, 2019, 1343 consecutive AHF patients (median 78 [69–85] year-old) were enrolled in a prospective, multicenter registry in Japan. Trends over time in tolvaptan usage, along with the severity of heart failure status based on the Get With The Guideline-Heart Failure [GWTG-HF] risk score, and in-hospital outcomes were investigated. During the study period, tolvaptan usage has increased from 13.0 to 28.7% over time (p for trend = 0.07), and 49.4% started tolvaptan within 3 days after admission. The GWTG-HF risk score in the tolvaptan group has significantly decreased over time, while that in the non-tolvaptan group has unchanged. There were no differences in the in-hospital mortality rate between the patients with and without tolvaptan (6.7% vs. 5.8%). After revision of the Japanese clinical practice guidelines for AHF in March 2018, tolvaptan usage for AHF patients has steadily increased. However, in-hospital outcomes including mortality do not seem to be affected.

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“…A recent analysis observed that two thirds of patients with AHF did not require any further treatment beyond initial IV diuretic therapy 64 . However, over 30% of patients with AHF do not achieve clinical decongestion upon discharge, which is associated with higher one-year mortality and HF rehospitalizations 65 .…”

Section: Diuretic Resistancementioning

confidence: 99%

Medical management of acute heart failure

Kamran¹,

Tang²

2021

Fac Rev

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Despite recent advances in the treatment of chronic heart failure, therapeutic options for acute heart failure (AHF) remain limited. AHF admissions are associated with significant multi-organ dysfunction, especially worsening renal failure, which results in significant morbidity and mortality. There are several aspects of AHF management: diagnosis, decongestion, vasoactive therapy, goal-directed medical therapy initiation and safe transition of care. Effective diagnosis and prognostication could be very helpful in an acute setting and rely upon biomarker evaluation with noninvasive assessment of fluid status. Decongestive strategies could be tailored to include pharmaceutical options along with consideration of utilizing ultrafiltration for refractory hypervolemia. Vasoactive agents to augment cardiac function have been evaluated in patients with AHF but have shown to only have limited efficacy. Post stabilization, initiation of quadruple goal-directed medical therapy—angiotensin receptor-neprilysin inhibitors, mineral receptor antagonists, sodium glucose type 2 (SGLT-2) inhibitors, and beta blockers—to prevent myocardial remodeling is being advocated as a standard of care. Safe transition of care is needed prior to discharge to prevent heart failure rehospitalization and mortality. Post-discharge close ambulatory monitoring (including remote hemodynamic monitoring), virtual visits, and rehabilitation are some of the strategies to consider. We hereby review the contemporary approach in AHF diagnosis and management.

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In-Hospital Therapy for Heart Failure With Reduced Ejection Fraction in the United States

Cited by 37 publications

References 15 publications

Disease Management and Outcomes in Patients Hospitalized for Acute Heart Failure in Japan

Disease Management and Outcomes in Patients Hospitalized for Acute Heart Failure in Japan

Temporal trends in tolvaptan use after revision of national heart failure guidelines in Japan

Medical management of acute heart failure

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