scholarly journals Mortality and guideline‐directed medical therapy in real‐world heart failure patients with reduced ejection fraction

2021 ◽  
Author(s):  
Peter A. McCullough ◽  
Hirsch S. Mehta ◽  
Colin M. Barker ◽  
Joanna Van Houten ◽  
Sarah Mollenkopf ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Therapy ◽  
Real World ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients

scholarly journals MORTALITY AND GUIDELINE DIRECTED MEDICAL THERAPY IN HEART FAILURE PATIENTS WITH REDUCED EJECTION FRACTION: EVIDENCE FROM REAL WORLD DATA

2021 ◽  
Vol 77 (18) ◽  
pp. 670
Author(s):  
Peter A. McCullough ◽  
Hirsch Mehta ◽  
Colin Barker ◽  
Joanna Van Houten ◽  
Sarah Mollenkopf ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Therapy ◽  
Real World ◽  
Real World Data ◽  
World Data ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients

INCIDENCE AND PREDICTORS OF DYSKALEMIA IN REAL-WORLD HEART FAILURE PATIENTS WITH PRESERVED, MID-RANGE AND REDUCED EJECTION FRACTION

2018 ◽  
Vol 71 (11) ◽  
pp. A715 ◽  
Author(s):  
Gianluigi Savarese ◽  
Hong Xu ◽  
Marco Trevisan ◽  
Ulf Dahlstrom ◽  
Bertram Pitt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Real World ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients

Abstract 238: Heart Failure: Do We Get With the Guidelines?

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Jugeet Kanwal ◽  
NEHA PURI ◽  
Jonathan Finkel ◽  
Muhammad Sattar ◽  
Muhammad Usman Ali ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Therapy ◽  
Real World ◽  
Community Hospital ◽  
Acute Decompensated Heart Failure ◽  
Real World Data ◽  
Readmission Rates ◽  
Salt Restriction ◽  
Reduced Ejection Fraction

Background: Acute decompensated heart failure is a leading cause of hospitalizations in adults older than 65 years. While randomized trials have shown medical therapy to be effective in reducing heart failure hospitalisations, real-world data showing the effectiveness of their implementation and impact on readmissions is scarce. This study aimed to evaluate ACC/AHA directed discharge practices for patients with heart failure with reduced ejection fraction (HFrEF) at a community hospital and its effect on 30-day readmission rates. Methods: This was a retrospective analysis of 868 patients admitted to a community hospital with HFrEF. HFrEF was confirmed for patients based on their most recent Echocardiogram. Data collection points included age, comorbidities (HTN, DM, CKD) and ejection fraction on last Echo. There were 2 primary measured outcomes: medications at discharge and 30-day readmission rates for HFrEF. Discharge medications were subdivided into a combination of either {ACEI/ARB, Beta-blocker (BB) and Spironolactone} or {ACEI/ARB and BB} or {Nitrates/Hydralazine}-all combinations recognised as guideline directed medical therapy (GDMT); or BB alone or ACEI alone. Secondary outcomes included fluid and salt restriction recommendations on discharge and its effect on 30-day readmission rates. Results: After applying exclusion criteria, 320 patients admitted from 2016-2019 for HFrEF were assessed. Using descriptive analyses, it was found that 77% of patients (247/320) were appropriately discharged on GDMT including a combination of {ACEI/ARB, BB and Spironolactone (59/320)}, {ACEI/ARB and BB (173/320)} and {Nitrates/Hydralazine (15/320)}, respectively. The remaining 23% patients were discharged on ACEI or BB alone (73/320). Only 4.38% of patients discharged on ACEI/ARB, BB and Spironolactone were readmitted within 30 days. Similar results were seen across the ACEI/ARB and BB arm (9.38%) and the Nitrates/Hydralazine arm (1.88%). Readmission was significantly higher for patients discharged on a BB alone (27.78%) or ACEI alone (28.57%). Readmission rates for patients recommended fluid and salt restriction versus those who were not, were not statistically significant. Conclusion: While ACC/AHA guidelines in accordance with Target HF, recommend early initiation of GDMT in HFrEF, our study aimed to assess real world implementation of these guidelines at a community hospital. Our study found that while our readmission rates remained higher than the national average (21.9%) in patients discharged on ACEI or BB alone, in agreement with trials, readmission rates were significantly lower in patients discharged in each combination of GDMT. Our study highlights the importance of greater focus on providing high-value care with high compliance with GDMT to reduce readmissions and improve patient outcomes.

scholarly journals Validation of a novel framework defining the acceptable standard of care for heart failure with reduced ejection fraction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Lopes ◽  
F Albuquerque ◽  
P Freitas ◽  
J Presume ◽  
B Rocha ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Therapy ◽  
Real World ◽  
Standard Of Care ◽  
Left Ventricular Ejection ◽  
World Population ◽  
Reduced Ejection Fraction ◽  
Acceptable Standard ◽  
All Cause Mortality

Abstract Background In heart failure with reduced ejection fraction (HFrEF), uptitration of neurohormonal antagonists to trial-proven doses shown to reduce mortality is challenging and seldomly achieved in clinical practice. A major reason for underdosing of these agents is the lack of a clear description of what constitutes an acceptable standard of care in HFrEF. To address this limitation, a novel framework for describing the physician adherence to evidence-based treatment was recently proposed. The aim of our study was to evaluate and validate the proposed framework in a real-world population of patients with HFrEF. Methods A cohort of patients with HFrEF, defined as left ventricular ejection fraction (LVEF) <40%, under treatment with neurohormonal antagonists for at least 3 months were retrospectively identified at a tertiary hospital's Heart Failure Clinic. Demographic, clinical, echocardiographic and treatment data were assessed. Patients were divided in three strata for each neurohormonal antagonist, according to the proposed framework: Status I – patients receiving target doses or the highest tolerated dose; Status II – use of subtarget doses for reasons unrelated to clinically important intolerance; and Status III – not receiving the drug at any dose. The prognostic value of each strata was assessed for all-cause mortality. Results A total of 408 patients (mean age 68±12 years, 78% male, 63% ischemic etiology) were included. The median LVEF was 31% (IQR 25–36) and most patients were in NYHA class II or III [210 (51.5%) and 163 (40%), respectively]. Medical therapy is described in Table 1. During a median follow-up of 3.3 years (IQR 1.4–5.6), 210 patients died. On univariable analysis, achieving Status I of beta-blocker (BB) therapy (HR: 0.50; 95% CI: 0.32–0.81; P=0.004) or ACEi/ARB (HR: 0.56; 95% CI: 0.36–0.86; P=0.012) was associated with reduced all-cause mortality. The mortality of patients in Status II of BB or ACEi/ARB was similar to the mortality of those not receiving the drug (HR for BB: 0.90; 95% CI: 0.53–1.52; P=0.69 and HR for ACEi/ARB: 0.71; 95% CI: 0.42–1.18; P=0.182) – figure 1. Achieving Status I of BB remained independently associated with reduced mortality after adjustment for several clinical and echocardiographic confounders (n=13) (adjusted HR: 0.59; 95% CI: 0.35–0.98; P=0.041). Conclusions In this real-world population of patients with HFrEF, the vast majority of patients were in Status I of BB and ACEi/ARB therapy. Achieving Status I of BB therapy seems to be associated with reduced mortality, even after adjustment for several markers of disease severity, highlighting the need for uptitration of medical therapy to maximal tolerated doses according to trial-proven regimens. FUNDunding Acknowledgement Type of funding sources: None.

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