Abstract 16967: Predictors for Recovery of Ejection Fraction in Urban Cohort of Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonathan Francois ◽  
Mohammed AlSadawi ◽  
Christian Abrahim ◽  
Romy R Ortega ◽  
Inna Bukharovich
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Chart Review ◽  
Beta Blockers ◽  
P Value ◽  
City Hospital ◽  
Angiotensin Receptor ◽  
Aldosterone Antagonists ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor

Introduction: Despite the clinical and economic impact of heart failure with reduced ejection fraction (HFrEF), understanding surrounding factors associated with resolution of ejection fraction (EF) as well as its prognostic value, remains elusive. Hypothesis: Predictors for Recovery of EF may differ in African Americans compared to the general population. Methods: We conducted a single center retrospective chart review on patients following up in the adult heart failure clinic at our inner city hospital located in Central Brooklyn. Chart review of 312 patients was performed and data including, demographics, comorbidities, medications and echocardiographic parameters. Patients not on an ACE inhibitor or angiotensin receptor blocker (ARB) were excluded as were those with a diagnosis of heart failure with preserved ejection fraction. Results: Of 312 patients identified, 158 (50.6%) were male and 289 (92.6%) identified as African in ancestry. Mean time since diagnosis was 86.2 months (SEM 4.9). There were 113 (36.2%) patients who had recovery of ejection fraction to greater than 50%. There were 59 patients on Angiotensin Receptor-Neprilysin Inhibitor (ARNI) therapy. Patients on ARNI were less likely to have ventricular recovery with an Odds Ratio (OR) of 0.484. The duration of heart failure in the patients with ARNI was significantly less than those on ACE/ARB therapy, 29.15 months versus 99.49 months respectively (2 tailed P value for difference of means <0.0001). Beta blocker use and Aldosterone antagonism were also associated with a reduced likelihood of recovery in ejection fraction (OR 0.177 and 0.294) respectively. Other classes of medication as well as comorbidities including an ischemic etiology had no statistically significant impact. Conclusion: In our predominantly African American cohort of patients, key GDMT medication including ARNI, Beta blockers and aldosterone antagonists reduced the odds of EF recovery.

Abstract P097: Angiotensin Receptor Neprilysin Inhibition Improves Arterial Stiffness And Endothelial Function In Heart Failure With Reduced Ejection Fraction

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Sangeetha D Nathaniel ◽  
Shane McGinty ◽  
David G Edwards ◽  
William B Farquhar ◽  
Melissa A Witman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arterial Stiffness ◽  
Ejection Fraction ◽  
Endothelial Function ◽  
Repeated Measures ◽  
Vascular Function ◽  
Nyha Class ◽  
Angiotensin Receptor ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor

The mechanisms for the benefits of Angiotensin Receptor Neprilysin inhibitor (ARNi) in heart failure patients with reduced ejection fraction (HFrEF) are likely beyond blood pressure (BP) reduction. Vascular function, a prognostic marker in HFrEF, improves with ARNi in animal models. Improvements in vascular function may contribute to benefits from ARNi in HFrEF; however, this has yet to be demonstrated in humans. The purpose of the study was to test the hypothesis that arterial stiffness and endothelial function would improve after 12 weeks of ARNi in HFrEF. Methods: HFrEF participants with NYHA class II-III were enrolled from local cardiology clinics and completed experimental visits at baseline and 12 weeks later: 13 participants were prescribed ARNi by their cardiologist [62±10 years, Men: 10, BMI: 30±5 kg/m 2 , EF: 28±6 %; Non-ischemic cardiomyopathy (NICM): 8], 10 participants continued on conventional treatment [CON: 60±7 years, Men: 6, BMI: 31±6 kg/m 2 , EF: 31±5 % and NICM: 4; all P=NS]. During each experimental visit, arterial stiffness was assessed via carotid-femoral pulse wave velocity (PWV; Sphygmocor PVx system) and endothelial function by brachial artery flow-mediated dilation (FMD) using standard techniques. Statistical analyses were performed using 2x2 repeated-measures ANOVA. Results: Baseline mean BP (MAP) was similar between ARNi (93±14 mmHg) and CON (85 ± 10 mmHg; P=0.13); MAP tended to decrease after 12 weeks of ARNi (88 ± 11 mmHg; P=0.08) but not CON (90 ± 17 mmHg; P=0.14) (ANOVA interaction P=0.03). PWV tended to be higher at baseline in ARNi (8.8 ± 2.5 m/s) compared to CON (7.0 ± 2.5 m/s; P=0.09); PWV decreased after 12 weeks of ARNi (7.0 ± 1.7 m/s; P<0.01) and was unchanged in CON (7.4 ± 2.4 m/s; P=0.33) (ANOVA interaction P<0.01). When controlling for MAP, the effect of ARNi on PWV remained (P<0.01). At baseline, FMD was similar between ARNi (2.81 ± 2.05%) and CON (4.75 ± 3.75%; P=0.13); however, FMD increased after 12 weeks of ARNi (5.73 ± 1.87%; P<0.001) but not in CON (5.37 ± 3.38%; P=0.33) (ANOVA time P<0.001, interaction P=0.01). Conclusion: ARNi improves arterial stiffness and endothelial function in HFrEF. Understanding the mechanisms of ARNi in HFrEF is crucial as it may pave the way for better interventions in other cardiovascular diseases.

scholarly journals Should Angiotensin Receptor Neprilysin Inhibitors Replace Angiotensin-converting Enzyme Inhibitors in Heart Failure With a Reduced Ejection Fraction?

2016 ◽  
Vol 2 (1) ◽  
pp. 47 ◽  
Author(s):  
Sam Hayman ◽  
John J Atherton ◽  
◽  
◽  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor

Angiotensin-converting enzyme inhibitors (ACEIs) have been the cornerstone of treatment of heart failure with reduced ejection fraction (HFrEF) for over two decades. Inhibition of neprilyisin augments vasoactive substances including natriuretic peptides, which may have multiple advantageous effects in chronic HF. Early studies of neprilyisin inhibition led to drug discontinuation due to lack of efficacy or safety concerns. Sacubitril/valsartan is a first-in-class combined angiotensin receptor/neprilysin inhibitor (ARNI). The PARADIGM-HF study demonstrated robust superiority of ARNI compared with enalapril in patients with chronic symptomatic HFrEF, raising the question of whether ACEI should still have a role in the management of HFrEF.

scholarly journals «Grey zone» of heart failure

2018 ◽  
Vol 99 (4) ◽  
pp. 651-656
Author(s):  
P Yu Galin ◽  
S A Kulbaisova ◽  
N Erov
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Research Work ◽  
Epidemiological Studies ◽  
Response To Treatment ◽  
Grey Zone ◽  
Preserved Ejection Fraction ◽  
Aldosterone Antagonists ◽  
Reduced Ejection Fraction

The review is devoted to modern understanding of heart failure with mid-range ejection fraction. The formation of the paradigm of «two phenotypes» of heart failure began around the end of the last century. As a result of a number of large epidemiological studies on heart failure with preserved ejection fraction, so-called «grey zone» of ejection fraction values was formed in the range of about 40-50%. This situation arose because of the lack of clearly established level of normal ejection fraction and underlines imperfection of this parameter as the only classification criterion. But no more convenient «tool» for research work was offered. In the past decade, «grey zone» of heart failure has been actively explored by clinical epidemiologists and clinicians. Should we classify these patients as one of the existing phenotypes of heart failure or present them as a new, separate phenotype? Both the first and second decisions require information about the population «portrait» of subgroup, about their response to treatment, and presumptive pathophysiological mechanisms of heart failure. In 2016 European society of cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure, heart failure with mid-range ejection fraction was determined as a separate subgroup to stimulate the search for such data. At the moment mid-range ejection fraction is known to be recorded in about 10-20% of patients with heart failure. They have substantial comorbidities as patients with preserved ejection fraction but the prevalence of ischemic heart disease in this subgroup makes it similar to heart failure with reduced ejection fraction. The response to treatment with beta-blockers and aldosterone antagonists is similar to that of heart failure with reduced ejection fraction. It is important that the mortality rates in all three groups of patients are approximately the same. This circumstance underlines the importance of further searche. Perhaps the research of «grey zone» of the syndrome will help to better understand pathophysiology of the existing heart failure phenotypes and confirm the validity of their identification based on ejection fraction.

Evaluation of the Usage and Dosing of Guideline-Directed Medical Therapy for Heart Failure With Reduced Ejection Fraction Patients in Clinical Practice

2021 ◽  
pp. 089719002110048
Author(s):  
Katelyn V. Smith ◽  
Jacqueline R. Dunning ◽  
Christina M. Fischer ◽  
Taylor E. MacLean ◽  
Joshua W. Bosque-Hamilton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Quality Improvement ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Academic Medical Center ◽  
Angiotensin Receptor ◽  
Improvement Project ◽  
Reduced Ejection Fraction ◽  
Tertiary Center

Background: Although strategies for optimization of pharmacologic therapy in patients with heart failure with reduced ejection fraction (HFrEF) are scripted by guidelines, data from HF registries suggests that guideline-directed medical therapies (GDMT) are underutilized among eligible patients. Whether this discrepancy reflects medication intolerance, contraindications, or a quality of care issue remains unclear. Objective: The objective of this initiative was to identify reasons for underutilization and under-dosing of HFrEF therapy in patients at a large, academic medical center. Methods: Among 500 patients with HFrEF enrolled in a quality improvement project at a tertiary center, we evaluated usage and dosing of 4 categories of GDMT: ACE inhibitors/Angiotensin Receptor Blockers (ACE-i/ARB), Angiotensin Receptor-Neprilysin Inhibitors (ARNi), beta blockers, and Mineralocorticoid Receptor Antagonists (MRA). Reasons for nonprescription and usage of suboptimal doses were abstracted from notes in the chart and from telephone review of previous medication trials with the patient. Results: Of 500 patients identified, 472 subjects had complete data for analysis. Among eligible patients, ACE-i/ARB were prescribed in 81.4% (293 of 360) and beta blockers in 94.4% (442 of 468). Of these patients, 10.6% were prescribed target doses of ACE-i/ARB and 12.4% were prescribed target doses of beta blockers. Utilization of other categories of GDMT was lower, with 54% of eligible patients prescribed MRAs and 27% prescribed an ARNi. In most cases, the reasons for nonprescription or under-dosing of GDMT were not apparent on review of the health record or discussion with the patient. Conclusion: Clear rationale for nonprescription and under-dosing of GDMT often cannot be ascertained from detailed review and is only rarely related to documented medication intolerance or contraindications, suggesting an opportunity for quality improvement.

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