MO191MANAGEMENT OF HYPERKALAEMIA TO FACILITATE RAASI THERAPY IN PATIENTS WITH HEART FAILURE IN A BESPOKE UK CLINIC

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ibrahim Ali ◽  
Philip A Kalra
Keyword(s):  
Heart Failure ◽  
Serum Potassium ◽  
Left Ventricular Systolic Dysfunction ◽  
Care Pathway ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Systolic Dysfunction ◽  
Systolic Heart Failure ◽  
Left Ventricular

Abstract Background and Aims Best practice for treatment of patients with chronic heart failure involves beta-blockers and renin-angiotensin-aldosterone system inhibitors (RAASi) such as ACE inhibitors (ACE-i), angiotensin receptor blockers (ARB), mineralocorticoid antagonists (MRA) and neprolysin inhibitor/ARB. However, use of these agents, and optimisation of their dosage, is frequently limited by hyperkalaemia, the incidence of which is increased by the co-prevalence of chronic kidney disease (CKD). Management of patients in a bespoke Hyperkalaemia Clinic can be advantageous in facilitating optimal use of RAASi. Method A Hyperkalaemia Clinic was opened in July 2019 in this tertiary renal centre within an NHS trust that hosts 4 district hospital heart failure services. Referrals of patients with left ventricular systolic dysfunction whose RAASi could not be optimised because of hyperkalaemia were encouraged from heart failure specialist nurses and cardiologists. Management of the patients incorporated commencement of patiromer at 8.4g daily and increases in RAASi was usually devolved to the referring team. This report describes the activity and short-term outcomes of the first 17 months after opening of the clinic (follow up until 1st January 2021). Results 34 patients with systolic heart failure and problems with RAASi-associated hyperkalaemia were referred to the clinic. Mean age was 74 (range 44-88) years, 28% had stage 3a, 28% 3b and 8% stage 4 CKD. ACE-I or ARB were being used in 73% of patients at referral, 73% were using beta blockers and 50% MRA with loop diuretic use in 70%. At first visit 64% had normokalaemia, and 36% serum potassium 5.4-6.0 mmol/L. During follow-up, 6 (18%) patients discontinued patiromer due to gastrointestinal side effects, 3 no longer required the binder because of decrease in RAASi use and 2 patients died (one each from stroke and sepsis). One patient was switched to an alternative potassium binder. As of 1st January 2021, patiromer was still being administered to 22 (65%) patients, 8 of which had received this for >12 months; all patients remained normokalaemic and none of them required magnesium supplementation. An increase in RAASi therapy had occurred in only 12 (35%) patients. Conclusion Our experience demonstrates the relative simplicity of managing hyperkalaemia via a bespoke clinic in cardio-renal patients. As this was nephrology-led, optimised management was dependent upon the assertive and collaborative involvement of the referring heart failure teams who helped with biochemical monitoring and alteration of RAASi therapy. However, less than half of the patients benefitted from an increase in RAASi therapy after normalisation of serum potassium, and there was definitely scope for improving this component of the care pathway via more direct multi-disciplinary interaction with the heart failure teams.

scholarly journals A Comparative Open Labelled Study on Ivabradine and Bisoprolol Prescribed in Combination Versus Maximum Dose Titration of Bisoprolol in Patients with Systolic Heart Failure and Left Ventricular Systolic Dysfunction

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Beta Blockers ◽  
Systolic Dysfunction ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Functional Class ◽  
Ventricular Systolic Dysfunction ◽  
Nyha Functional Class ◽  
Group 2

Background: Increased resting heart rate is associated with cardiovascular outcomes in patients with heart failure and reduced ejection fraction (HFrEF). Despite high volume prescribers of beta blockers patients does not achieve recommended target heart rate. The primary objective of this study was to assess the efficacy of ivabradine as adjunct therapy with beta blockers in south east Asian population systolic heart failure and left ventricular systolic dysfunction. Methodology: This single center, open labelled, randomized study included 113 patients in sinus rhythm with HFrEF and left ventricular systolic dysfunction from outpatient department. Ivabradine was initiated in 45% patients with SR. Patients with LVEF < 35% by Teichholz method, NHYA class II-III, sinus rhythm and resting HR > 70 bpm, already on bisoprolol 5 mg were divided into 2 groups; Group 1 (n= 56) patients were uptitrated to bisoprolol 10 mg and Group 2 (n= 57) patients received ivabradine 5 mg b.i.d in addition to bisoprolol 5 mg. Blood samples for NTproBNP level, an ECG, echocardiogram, NYHA functional class, systolic and diastolic BP were taken at baseline and at the end of 6 months follow-up in both groups Results: After 6 months HR decreased significantly from 94.82±7.03 to 68.75±5.35 bpm (p < 0.0001), with more patients in NHYA functional Class I than Class II and III and decrease in BNP level from 969.8.3±348.9 to 348.6±230.2 pg/ml (p < 0.0001) in group 2 patients. A significant increase in LVEF was observed with the addition of ivabradine from 31.40±5.37 to 41.68±5.33 % (p < 0.0001). However, mean systolic and diastolic blood pressure was not affected by the addition of ivabradine. Conclusion: This study concludes that patients with HFrEF demonstrated good tolerability, efficacy and NYHA functional class with the combination of ivabradine and bisoprolol therapy.

scholarly journals Enhanced Inflammation is a Marker for Risk of Post-Infarct Ventricular Dysfunction and Heart Failure

2020 ◽  
Vol 21 (3) ◽  
pp. 807 ◽  
Author(s):  
Iwona Świątkiewicz ◽  
Przemysław Magielski ◽  
Jacek Kubica ◽  
Adena Zadourian ◽  
Anthony N. DeMaria ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Multivariable Analysis ◽  
High Sensitivity ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Reactive Protein

Acute ST-segment elevation myocardial infarction (STEMI) activates inflammation that can contribute to left ventricular systolic dysfunction (LVSD) and heart failure (HF). The objective of this study was to examine whether high-sensitivity C-reactive protein (CRP) concentration is predictive of long-term post-infarct LVSD and HF. In 204 patients with a first STEMI, CRP was measured at hospital admission, 24 h (CRP24), discharge (CRPDC), and 1 month after discharge (CRP1M). LVSD at 6 months after discharge (LVSD6M) and hospitalization for HF in long-term multi-year follow-up were prospectively evaluated. LVSD6M occurred in 17.6% of patients. HF hospitalization within a median follow-up of 5.6 years occurred in 45.7% of patients with LVSD6M vs. 4.9% without LVSD6M (p < 0.0001). Compared to patients without LVSD6M, the patients with LVSD6M had higher CRP24 and CRPDC and persistent CRP1M ≥ 2 mg/L. CRP levels were also higher in patients in whom LVSD persisted at 6 months (51% of all patients who had LVSD at discharge upon index STEMI) vs. patients in whom LVSD resolved. In multivariable analysis, CRP24 ≥ 19.67 mg/L improved the prediction of LVSD6M with an increased odds ratio of 1.47 (p < 0.01). Patients with LVSD6M who developed HF had the highest CRP during index STEMI. Elevated CRP concentration during STEMI can serve as a synergistic marker for risk of long-term LVSD and HF.

scholarly journals Review: Effective Implementation of the New ESC Guidelines for the Management of Chronic Heart Failure in Routine Clinical Practice

2005 ◽  
Vol 6 (2_suppl) ◽  
pp. S6-S10 ◽  
Author(s):  
Karl Swedberg
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Angiotensin Receptor Blockers ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
High Dose ◽  
Mortality And Morbidity ◽  
European Guidelines ◽  
Receptor Blockers

European guidelines for the management of chronic heart failure (CHF) have been recently updated. Key changes include emphasis on CHF with preserved ejection fraction, and recognition of the role of angiotensin receptor blockers (ARBs) in the management of CHF patients with left ventricular systolic dysfunction who remain symptomatic despite optimal therapy, or who are intolerant to angiotensin-converting enzyme (ACE) inhibitors. Recent trials that clearly demonstrated significant mortality and morbidity benefits were integral to these new recommendations. Additionally, a high dose of an ARB, as demonstrated in the Candesartan in Heart Failure Assessment of Reduction in Mortality and morbidity (CHARM) programme, can significantly reduce hospitalisation for heart failure in these settings. The guidelines recommend that only those ARBs and doses used in clinical trials should be considered, taking into account current licensed indications. Clinicians who are directly involved in the management of CHF must play a key role in the dissemination of these guidelines to colleagues to ensure that optimal CHF management is integrated into standard practice.

HFrEF pharmacological treatment: beta blockers

ESC CardioMed ◽  
2018 ◽  
pp. 1851-1862
Author(s):  
Simon Alistair ◽  
Stuart Beggs ◽  
Roy Stuart Gardner
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricular Systolic Dysfunction ◽  
Beta Blockers ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Black Patients ◽  
Patients With Heart Failure ◽  
Obstructive Airways Disease ◽  
Practical Guidance

By incremental steps over several decades of research, beta blockers have evolved ‘from bench to bedside’, emerging as a keystone of modern optimal pharmacotherapy for heart failure. This chapter starts by detailing the story of their development, focusing on the randomized trials that established their clinical efficacy in reducing hospitalization and death. Subsequently, issues such as the potential heterogeneity among different beta-blocker agents and the appropriate dose targets in heart failure are discussed. Advice regarding the initiation, titration, and discontinuation of beta blockers is presented, providing practical guidance for healthcare professionals who manage patients with heart failure. Finally, the chapter explores the evidence underlying the use of beta blockers in specific populations, such as elderly patients, black patients, and those with atrial fibrillation, obstructive airways disease, or asymptomatic left ventricular systolic dysfunction.

scholarly journals Gaps in Medical and Device Therapy for Patients with Left Ventricular Systolic Dysfunction: The EchoGap Study

2014 ◽  
Vol 8 (1) ◽  
pp. 94-101
Author(s):  
Hisham Dokainish ◽  
Lauren Jewett ◽  
Robby Nieuwlaat ◽  
Joshua Coulson ◽  
Catherine Demers ◽  
...  
Keyword(s):  
Left Ventricular Systolic Dysfunction ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Evidence Based ◽  
Ventricular Systolic Dysfunction ◽  
Academic Medical Centre ◽  
Medicine Prescription ◽  
Prescription Rates

Objectives: To assess gaps between guidelines and medicine prescription/dosing and referral for defibrillator therapy in patients with left ventricular systolic dysfunction (LVSD). Methods: Outpatient echocardiography reports at an academic hospital centre were screened and outpatients with LVEF<40% were included. A questionnaire was mailed to the patients’ physician, querying prescription/dosing of ACE-inhibitors (ACEi), angiotensin receptor blockers (ARB) and beta-blockers (BB). Patients with LVEF<30% had additional questions on implantable cardiac defibrillator (ICD) referral. Results: Mean age was 69.6+/-12.2 years and mean LVEF was 29.7+/-6.5%. ACEi and/or ARB prescription rate was 260/309(84.1%) versus 256/308(83.1%) for BB (p=NS for comparison). Of patients on ACEi, 77/183(42.1%) were on target dose, compared to 7/45(15.5%) for ARB and 9/254(3.5%) for BB (p<0.01). Of 171/309 patients (55.3%) with LVEF<30%, 72/171(42.1%) had an ICD and 16/171(9.4%) were referred for one. Conclusion: Prescription rates of evidence-based HF medicines are relatively high in outpatients with LVSD referred for echocardiography at this Canadian academic medical centre; however, the proportion of patients at target doses was modest for ACEi and low for ARB and BB. Approximately half of patients who qualify for ICD by EF alone have one or were referred. Important reasons for patients with LVSD not on evidence-based therapy were identified.

P1493Cardiac contractility modulation in left ventricular systolic dysfunction: 1-year single Centre experience and clinical outcome

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Matta ◽  
C Devecchi ◽  
F De Vecchi ◽  
L Barbonaglia ◽  
E Occhetta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Nyha Class ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Walking Test ◽  
Ischaemic Cardiomyopathy

Abstract Funding Acknowledgements None Introduction. Cardiac contractility modulation (CCM) is a treatment option for patients suffering symptomatic chronic heart failure (CHF) with reduced ejection fraction (LVEF) despite optimal medical therapy, who are not eligible for or non-responders to cardiac resynchronization therapy (CRT). Despite randomized trials showing benefit in the short term, data on mid-term follow-up (over 12 months) are limited to small observational studies. Purpose. The aim of this observation, prospective study is to assess the impact of CCM therapy on quality of life, symptoms, exercise tolerance and left ventricular function in a population of patients with CHF and moderate-to-severe left ventricular systolic dysfunction. Methods. Consecutive patients suffering from CHF with LVEF &lt;45%, symptomatic, in NYHA class &gt; II despite optimal medical therapy, underwent CCM implantation at our Centre from October 2017 to October 2018. Enrolled patients underwent baseline evaluation and at 3, 6 and 12 months with transthoracic echocardiogram, ECG, clinical assessment, 6-min hall walking test and Minnesota Living With Heart Failure Questionnaire (MLWHFQ). Results. Overall, 10 patients underwent CCM implantation (100% males, mean age 70 ± 8 years, 80% ischaemic cardiomyopathy, mean LVEF 29.4 ± 8%). All patients had at least one hospitalization for worsening heart failure during the previous 12 months. After a mean follow-up of 15 months, 9 patients were alive, while one patient died for worsening heart failure precipitated by pneumonia 2 months following CCM implantation. Among the remaining 9 patients, LVEF improved non-significantly to 32.2 ± 10% (p = 0.092), 6-min walking test distance improved from 170 ± 132 m to 305 ± 99 m (p &lt; 0.001), mean NYHA class improved from 3.0 ± 0.4 to 1.6 ± 0.5 (p = 0.003) and MLWHFQ score improved from 59.0 ± 33 to 34.0 ± 38 (p = 0.037) (Figure 1). Only 2 patients have been hospitalized during the 12 months, for worsening heart failure and sustained ventricular tachycardia, respectively. Overall, a net clinical benefit was detected in 6 out of 9 patients. Among the responders, 2 patients were device-naïve, presenting LVEF &gt; 35%; one patient was a CRT non-responder, while the remaining 3 had narrow QRS. All the non-responders patients had ischaemic cardiomyopathy, one of them with a moderately reduced LVEF and one with a CRT. Conclusion. CCM is effective in improving quality of life, symptoms and exercise tolerance, and reduces hospitalizations in patients with symptomatic CHF on top of optimal medical and electrical therapy. The benefit in responders is maintained over one year after implantation, so this treatment should be considered for highly symptomatic patients suffering from CHF and reduced LVEF. Abstract Figure 1

scholarly journals Peripartum Cardiomyopathy

1970 ◽  
Vol 24 (2) ◽  
pp. 67-70
Author(s):  
Shirin Akter Begum ◽  
SB Chowdhury ◽  
Begum Nasrin ◽  
Jannatul Ferdous ◽  
Zillur Rahman Bhuiyan
Keyword(s):  
African American Women ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Systolic Dysfunction ◽  
The United States ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Objective Evidence

Peripartum cardiomyopathy (PPCM) is a rare but potentially lethal complication of pregnancy occurring in approximately 1in 3000 live births in the United States although some series report a much higher incidence. African-American women are particularly at risk. Diagnosis requires symptoms of heart failure in the last month of pregnancy or within five months of delivery in the absence of recognized cardiac disease prior to pregnancy as well as objective evidence of left ventricular systolic dysfunction. Obstetricians should suspect the diagnosis, particularly if the patient has risk factors. Evaluation should include an echocardiogram to assess the LV systolic function. Treatment includes ACE inhibitors or angiotensin receptor blockers, beta-blockers, and diuretics. Consideration should be given to anticoagulation. A number of causes are being investigated, including nutritional, infectious, and genetic, which, hopefully, lead to more targeted treatments. This paper provides an updated, comprehensive review of PPCM, including emerging insights into the etiology of this disorder as well as current treatment options. Bangladesh J Obstet Gynaecol, 2009; Vol. 24(2) : 67-70   DOI: http://dx.doi.org/10.3329/bjog.v24i2.8531

Sign in / Sign up

Export Citation Format

Share Document