Pharmacologic Therapy for Heart Failure With Reduced Ejection Fraction: Closing the Gap Between Clinical Guidelines and Practice

Biglane, J. Barr; Becnel, Miriam; Ventura, Héctor O.; Krim, Selim R.

doi:10.1016/j.pcad.2017.08.006

Cited by 14 publications

(10 citation statements)

References 49 publications

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“…[7] A substantial proportion of patients admitted with HF have significant treatment gaps. [8] The purpose of a multidisciplinary rounds program is to minimize the impact of educational and socioeconomic barriers in management of HF. The goal is to affect lifestyle modification, dietary patterns, and medication compliance to optimize management of HF.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary rounds in prevention of 30-day readmissions and decreasing length of stay in heart failure patients

et al. 2019

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To assess the impact of multidisciplinary rounds (MDR) on 30-day readmissions and length of stay in hospitalized patients with a diagnosis of congestive heart failure in a community teaching hospital. Patients with primary admission diagnosis of congestive heart failure (CHF) were included. A before and after retrospective study was conducted once the intervention was implemented in 2014. The before and after study periods were each of 1-year duration and included 181 and 151 patients, respectively. Our multidisciplinary heart failure rounding team consisted of a staff cardiologist, case manager, pharmacist, social worker, and a nutritionist. The mean length of stay decreased from 5.7 days to 5 days, and 30-day readmissions decreased from 27.6% to 17.22% ( P -value .026) after implementation of the multidisciplinary rounding. We observed a significant decrease of readmissions in ischemic cardiomyopathy (ICM) (from 33.61% to 14.01%; P -value .007) and heart failure with reduced ejection fraction (HFrEF) (from 31.34% to 16.05%; P -value .028) patients. There was an increase in the percentage of patients hospitalized with non-ischemic cardiomyopathy (NICM) and heart failure with preserved ejection fraction (HFpEF) and, in particular, women patients with heart failure. Implementation of MDR program on CHF patients resulted in significant decrease in both readmission rate and length of stay in our hospital.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary rounds in prevention of 30-day readmissions and decreasing length of stay in heart failure patients

et al. 2019

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“…However, obese patients are often underrepresented in clinical trials and therefore evidence on their management remains scant. In order to expand knowledge on the management of these patients, anecdotal case reports may be considered [8]. …”

Section: Discussionmentioning

confidence: 99%

“…Notably, this factor is associated with increased mortality in HF patients, as well as with a number of other comorbidities [7]. Moreover, the presence of obesity may indeed pose new challenges to the clinician, also because obese patients are often excluded from clinical trials and therefore evidence on the management of these patients remains scant [8]. To our knowledge, treatment with sacubitril/valsartan in obese patients has rarely been investigated.…”

Section: Introductionmentioning

confidence: 99%

Pharmacological Management of a Heart Failure Patient with Severe Obesity

Riccio

2017

Cardiology

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Obesity is one of the commonest comorbidities in patients with heart failure, and it is associated with increased mortality risk. However, obese patients are often underrepresented in clinical trials and therefore evidence on their management remains scant. In order to expand knowledge on the management of these patients, anecdotal reports may be considered. In the present case report, we discuss the successful management of an obese patient who received sacubitril/valsartan therapy. This treatment was initiated after a 12-month period of losartan therapy, which did not provide any benefit in terms of heart function. Importantly, during this period the patient required frequent hospitalizations, with a marked decrease in quality of life. After the switch to sacubitril/valsartan, a 10% increase in left ventricular ejection fraction was observed (from 30 to 40%) over a 12-month period. Moreover, no hospitalizations were required, and the patient was able to carry on at least some of his daily activities.

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“…The mainstay of pharmacological treatment for HFrEF is neurohormonal blockade with the aim to limit disease progression, improve symptoms and quality of life, and reduce mortality [ 12 ]. The neurohormonal antagonist drugs used for the treatment of patients with HFrEF include well-established drugs like angiotensin-converting enzyme inhibitors (ACEi) [angiotensin receptor blockers (ARB) if an ACEi is not tolerated], beta blockers (BB), mineralocorticoid receptor antagonists (MRA), and the more recent angiotensin receptor neprilysin inhibitor (ARNI) [ 13 – 15 ]. Other disease-modifying drugs that have shown benefit in HFrEF include hydralazine and isosorbide dinitrate combination, I f -channel blocker, and dapagliflozin [ 16 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of neurohormonal antagonists on blood pressure in patients with heart failure with reduced ejection fraction (HFrEF): a systematic review protocol

et al. 2020

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Background: Several cardiovascular pathologies cause heart failure. Heart failure with reduced ejection fraction (HFrEF) is deteriorated by neurohormonal activation, so neurohormonal antagonists are recommended in HFrEF patients. They improve morbidity, mortality, and quality of life and reduce hospital admissions. Heart failure treatment guidelines recommend achieving target doses of those drugs. However, many clinicians prescribe suboptimal doses for the fear of inducing hypotension. The aim of this systematic review and meta-analysis is to understand whether it is still beneficial to uptitrate the doses of those drugs even if the patient is at the risk of developing hypotension. Methods: The primary outcome is symptomatic or asymptomatic hypotension in patients on neurohormonal antagonist drugs for HFrEF. Secondary outcomes are blood pressure reduction, New Yok Heart Association functional class deterioration, non-fatal cardiovascular events, cardiovascular mortality, all-cause mortality, heart failure hospitalizations, and adverse events. Randomized controlled trials involving adults with HFrEF will be included. Comprehensive literature search will be done in MEDLINE, Scopus, Web of Science, WHO Global Index Medicus, and the Cochrane Central Register of Controlled Trials. MEDLINE will be searched first using controlled vocabulary and free text terms and then adapted to other databases. Linear and nonlinear dose-response metaanalyses will be conducted. Publication bias and statistical heterogeneity will be tested by Egger's regression and Cochran's Q tests, respectively. Sensitivity, subgroup, and meta-regression analyses will be performed. Grading of Recommendations Assessment, Development and Evaluation approach will be used to judge the quality of evidence.

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Pharmacologic Therapy for Heart Failure With Reduced Ejection Fraction: Closing the Gap Between Clinical Guidelines and Practice

Cited by 14 publications

References 49 publications

Multidisciplinary rounds in prevention of 30-day readmissions and decreasing length of stay in heart failure patients

Multidisciplinary rounds in prevention of 30-day readmissions and decreasing length of stay in heart failure patients

Pharmacological Management of a Heart Failure Patient with Severe Obesity

Effects of neurohormonal antagonists on blood pressure in patients with heart failure with reduced ejection fraction (HFrEF): a systematic review protocol

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