Abstract 15483: A Clinic-based Intervention Achieves Target Doses of Guideline-directed Medical Therapy in Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ann Rogerson ◽  
marvin R Allen ◽  
Renea L Beckstrand ◽  
Bradi B Granger
Keyword(s):  
Heart Failure ◽  
Patient Satisfaction ◽  
Medical Therapy ◽  
Repeated Measures ◽  
Beta Blockers ◽  
Reduced Ejection Fraction ◽  
Appointment Attendance ◽  
Mineralocorticoid Antagonists ◽  
Composite Scores ◽  
Person Centered Approach

Introduction: Target doses of guideline-directed medical therapy (GDMT) reduce morbidity and mortality, and yet, are challenging to achieve in patients with heart failure and reduced ejection fraction (HFrEF). Long-term, relationship-based approaches are not well described. Methods: We implemented a person-centered approach in a nurse-managed multidisciplinary heart failure clinic. We used repeated measures analysis to prospectively evaluate patient satisfaction, appointment attendance, dose optimization of GDMT for renin-angiotensin inhibitors, beta-blockers (BB), mineralocorticoid antagonists (MRA), and anticoagulation, and ICD placement and cardiac rehab participation at 12 months. GDMT was scored 0-6, with one point for each guideline-indicated therapy. Composite scores were compared using ANOVA at baseline, 6-months, and 12-months. Results: Participants (n=102) were age 68 (± 14.95) years on average, predominantly white (95.1%), male (62.75%), and high school graduates (88.24%). At 12-months, the proportion of patients on ≥50% of target doses improved: renin-antiotensin inhibitors from 27% to 41%, beta-blockers from 46% to 64%, and MRA from 35% to 65%. Cardiac rehab attendance improved from 25% to 84%. Patient satisfaction with care improved; four (3.9%) patients did not attend scheduled follow-up in the 12-month period. Though overall composite scores of GDMT improved (F=51.74, p <0.001), only 12% of patients achieved target doses for all 3 medication classes concomitantly. No participants were readmitted within 30 days of HF-hospitalization; all-cause 30-day readmission was 10.5%. Conclusion: A persistent patient-provider relationship and person-centered approach to HF management may improve GDMT.

Abstract 17470: Racial Disparities in Goal Directed Medical Therapy in Patients With Systolic Heart Failure- A Single Center Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ayesha Azmeen ◽  
Naga Vaishnavi Gadela ◽  
Vergara Cunegundo
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Racial Disparities ◽  
Beta Blockers ◽  
Systolic Heart Failure ◽  
The United States ◽  
Clinical Syndrome ◽  
Single Center ◽  
Geographic Variations ◽  
Reduced Ejection Fraction

Introduction: Heart failure(HF) is a clinical syndrome that is widely prevalent affecting approximately 6.5 million people in the United States. It accounts for the ever-rising health care costs in the US due to recurrent hospitalizations. Despite advancements in medical management, the mortality and the rate of hospitalizations continues to be high with geographic variations and racial disparities. Through this descriptive study, we sought to analyze the health disparities among Hispanic, African American (AA) and Caucasian population in a single-center. Methods: We identified a total of 178 patients with HF with reduced ejection fraction from our outpatient clinic by utilizing the ICD-10 codes. Patients with ejection fraction >50% have been excluded. A retrospective chart review of their ethnic background, medications, and number of heart failure exacerbations per year has been performed. Results: 178 patients (mean age 62 years, 35.56% of females) including Hispanics (n=102), AA(n=44), and Caucasians (n=32) were included in the study. Although all patients were started on Beta-blockers, only 76.4% and 37.2% of Hispanics were started on ACEi/ARBs and spironolactone respectively. Similarly, 72.7% and 45.4% of AA were started on ACEi/ARBs and spironolactone respectively. This is in contrast to Caucasians population, where a majority of patients were on started on GDMT; 90% and 75% were started on ACEi/ARBs and spironolactone respectively. This was also reflected by the number of admissions due to HF exacerbations which ranged from 2-4/year for Hispanics and AA populations and 0-1/year for Caucasians. Conclusions: GDMT for HF is known to reduce heart failure exacerbations, mortality and the ever rising cost of the healthcare system. We have observed that despite recommendations to initiate GDMT in all patients with HF with reduced ejection fraction, racial disparities exist. Physicians should be mindful of initiating GDMT in all patients.

scholarly journals Evaluation of a guideline directed medical therapy titration program in patients with heart failure with reduced ejection fraction

2019 ◽  
Vol 22 ◽  
pp. 1-5 ◽  
Author(s):  
Kathir Balakumaran ◽  
Aadhar Patil ◽  
Shannon Marsh ◽  
Joseph Ingrassia ◽  
Chia-Ling Kuo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

scholarly journals Targeting Endothelial Function to Treat Heart Failure with Preserved Ejection Fraction: The Promise of Exercise Training

2017 ◽  
Vol 2017 ◽  
pp. 1-17 ◽  
Author(s):  
Andreas B. Gevaert ◽  
Katrien Lemmens ◽  
Christiaan J. Vrints ◽  
Emeline M. Van Craenenbroeck
Keyword(s):  
Heart Failure ◽  
Endothelial Dysfunction ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Current Knowledge ◽  
Beta Blockers ◽  
Preserved Ejection Fraction ◽  
Cellular Mechanisms ◽  
Converting Enzyme Inhibitors ◽  
Reduced Ejection Fraction

Although the burden of heart failure with preserved ejection fraction (HFpEF) is increasing, there is no therapy available that improves prognosis. Clinical trials using beta blockers and angiotensin converting enzyme inhibitors, cardiac-targeting drugs that reduce mortality in heart failure with reduced ejection fraction (HFrEF), have had disappointing results in HFpEF patients. A new “whole-systems” approach has been proposed for designing future HFpEF therapies, moving focus from the cardiomyocyte to the endothelium. Indeed, dysfunction of endothelial cells throughout the entire cardiovascular system is suggested as a central mechanism in HFpEF pathophysiology. The objective of this review is to provide an overview of current knowledge regarding endothelial dysfunction in HFpEF. We discuss the molecular and cellular mechanisms leading to endothelial dysfunction and the extent, presence, and prognostic importance of clinical endothelial dysfunction in different vascular beds. We also consider implications towards exercise training, a promising therapy targeting system-wide endothelial dysfunction in HFpEF.

A heart failure care optimisation project in the north of Scotland

2020 ◽  
Vol 15 (9) ◽  
pp. 1-9
Author(s):  
Marianne O'Hara ◽  
Amanda Smith ◽  
Emma Foster ◽  
Stephen J Leslie
Keyword(s):  
Heart Failure ◽  
Medical Therapy ◽  
Real Life ◽  
Optimal Medical Therapy ◽  
Reduced Ejection Fraction ◽  
Heart Failure Care ◽  
The North ◽  
Patients With Heart Failure ◽  
Icd 10 ◽  
Project Data

Introduction: This project aimed to assess and optimise the treatment of all patients with heart failure with reduced ejection fraction (HFrEF). Methods: Consecutive patients discharged with a heart failure code (ICD-10) between April 2014 and July 2017 were included. The medical records were reviewed to ensure optimal medical therapy and in cases where this was not being received, a process of ‘active optimisation’ was initiated. Results: Out of 656 patients, 139 were identified as eligible for guideline-directed treatment, 129 (93%) of which were receiving optimal medical therapy. Of these, 47 (36%) were deemed to be optimised but were not on full guideline-directed therapy owing to contraindication, intolerance, comorbidities or non-compliance. Conclusion: The project data reflect real-world patients and practice and highlight a tension between guideline-based care and real-life (realistic) medicine.

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