scholarly journals Medical Treatment of Heart Failure with Reduced Ejection Fraction – Prognostic Indication

2017 ◽  
Vol 10 ◽  
Author(s):  
Giuseppe Rosano
Keyword(s):  
Heart Failure ◽  
Beta Blockers ◽  
Great Success ◽  
Therapeutic Approaches ◽  
First Line ◽  
Reduced Ejection Fraction ◽  
Medical Interventions ◽  
The Past ◽  
Patients With Heart Failure ◽  
First Line Treatment

An up-to-date review on guideline directed medical therapies that aim to improve prognosis in HFrEF patients.  Research on medical interventions that may improve prognosis in patients with chronic heart failure has had great success in the past decades. Therefore, there are well- established classes of drugs – ACEi, beta- blockers, MRAs – that should be used as first line treatment in all patients with heart failure. In the past few years newer therapeutic approaches have been shown to improve prognosis in patients with heart failure but, since the evidence generated by these newer classes of drugs is less than that of the first three classes of drugs these therapies should be implemented only after an initial treatment with the first line drugs has been implemented. This article reviews the advances that have achieved in the treatment of heart failure in terms of a prognostic benefit.

scholarly journals It is easy to see, but it is better to foresee: a case report on the favourable alliance between CardioMEMS and levosimendan

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Valeria Visco ◽  
Cristina Esposito ◽  
Paolo Vitillo ◽  
Carmine Vecchione ◽  
Michele Ciccarelli
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Optimal Management ◽  
Reduced Ejection Fraction ◽  
The Past ◽  
Case Summary ◽  
Pressure Profiles ◽  
Patients With Heart Failure

Abstract Background In the past years, different devices have been investigated to help in identifying early decompensation events in patients with heart failure (HF) and reduced ejection fraction (EF), reducing hospital admissions. In this report, we present the first patient experience with levosimendan infusion led by CardioMEMS. Case summary A 68-year-old man with HF and reduced EF with more than 20 hospitalizations for exacerbation of HF was enrolled in our HF Clinic from October 2017. Echocardiogram showed a dilated left ventricle with severely reduced EF (29%) and increased pulmonary artery systolic pressure (40 mmHg). From October 2017 to May 2019, the patient went through numerous hospitalizations, despite optimal medical therapy; subsequently, was adopted a strategy of levosimendan infusions guided by CardioMEMS. Levosimendan infusions improved haemodynamic and pressure profiles. The patient was monitored daily by CardioMEMS, and from June to December 2019, he had only two hospitalizations scheduled for levosimendan infusion and none for HF exacerbation. Discussion Our case supports the combination of CardioMEMS and levosimendan for the optimal management of patients with advanced HF. These results further strengthen the development of a randomized clinical trial to demonstrate the clinical usefulness of this device in combination with the levosimendan infusion programme in advanced HF patients.

scholarly journals SO057BETA-BLOCKERS ARE ASSOCIATED WITH REDUCED MORTALITY IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION AND ADVANCED CHRONIC KIDNEY DISEASE: COHORT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Edouard L Fu ◽  
Alicia Uijl ◽  
Friedo W Dekker ◽  
Lars H Lund ◽  
Gianluigi Savarese ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Advanced Chronic Kidney Disease ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Abstract Background and Aims Beta-blockers reduce mortality and morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, patients with advanced chronic kidney disease (CKD) were underrepresented in landmark trials. We evaluated if beta-blockers are associated with improved survival in patients with HFrEF and advanced CKD. Method We identified 3906 persons with an ejection fraction <40% and advanced CKD (eGFR <30 mL/min/1.73m2) enrolled in the Swedish Heart Failure Registry during 2001-2016. The associations between beta-blocker use, 5-year all-cause mortality, and the composite of time to cardiovascular (CV) mortality/first HF hospitalization were assessed by multivariable Cox regression. Analyses were adjusted for 36 variables, including demographics, laboratory measures, comorbidities, medication use, medical procedures, and socioeconomic status. To assess consistency, the same analyses were performed in a positive control cohort of 12,673 patients with moderate CKD (eGFR <60-30 mL/min/1.73m2). Results The majority (89%) of individuals with HFrEF and advanced CKD received treatment with beta-blockers. Median (IQR) age was 81 (74-86) years, 36% were women and median eGFR was 26 (20-28) mL/min/173m2. During 5 years of follow-up, 2086 (53.4%) individuals had a subsequent HF hospitalization, and 2954 (75.6%) individuals died, of which 2089 (70.1%) due to cardiovascular causes. Beta-blocker use was associated with a significant reduction in 5-year all-cause mortality [adjusted hazard ratio (HR) 0.86; 95% confidence interval (CI) 0.76-0.96)] and CV mortality/HF hospitalization (HR 0.87; 95% CI 0.77-0.98). The magnitude of the associations between beta-blocker use and outcomes was similar to that observed for HFrEF patients with mild/moderate CKD, with adjusted HRs for all-cause mortality and CV mortality/HF hospitalization of 0.85 (95% CI 0.78-0.91) and 0.88 (95% CI 0.82-0.96), respectively. Conclusion Despite lack of trial evidence, the use of beta-blockers in patients with HFrEF and advanced CKD was high in routine Swedish care, and was independently associated with reduced mortality to the same degree as HFrEF with moderate CKD.

scholarly journals Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e030514 ◽  
Author(s):  
Won-Woo Seo ◽  
Jin Joo Park ◽  
Hyun Ah Park ◽  
Hyun-Jai Cho ◽  
Hae-Young Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Elderly Patients ◽  
Beta Blockers ◽  
Very Elderly ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Reduced Risk ◽  
Ras Inhibitors

Objectives and designGuideline-directed medical therapy (GDMT) with renin–angiotensin system (RAS) inhibitors and beta-blockers has improved survival in patients with heart failure with reduced ejection fraction (HFrEF). As clinical trials usually do not include very old patients, it is unknown whether the results from clinical trials are applicable to elderly patients with HF. This study was performed to investigate the clinical characteristics and treatment strategies for elderly patients with HFrEF in a large prospective cohort.SettingThe Korean Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients hospitalised for acute HF from 10 tertiary university hospitals in Korea.ParticipantsIn this study, 2045 patients with HFrEF who were aged 65 years or older were included from the KorAHF registry.Primary outcome measurementAll-cause mortality data were obtained from medical records, national insurance data or national death records.ResultsBoth beta-blockers and RAS inhibitors were used in 892 (43.8%) patients (GDMT group), beta-blockers only in 228 (11.1%) patients, RAS inhibitors only in 642 (31.5%) patients and neither beta-blockers nor RAS inhibitors in 283 (13.6%) patients (no GDMT group). With increasing age, the GDMT rate decreased, which was mainly attributed to the decreased prescription of beta-blockers. In multivariate analysis, GDMT was associated with a 53% reduced risk of all-cause mortality (HR 0.47, 95% CI 0.39 to 0.57) compared with no GDMT. Use of beta-blockers only (HR 0.57, 95% CI 0.45 to 0.73) and RAS inhibitors only (HR 0.58, 95% CI 0.48 to 0.71) was also associated with reduced risk. In a subgroup of very elderly patients (aged ≥80 years), the GDMT group had the lowest mortality.ConclusionsGDMT was associated with reduced 3-year all-cause mortality in elderly and very elderly HFrEF patients.Trial registration numberNCT01389843.

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