scholarly journals Towards tailoring blood pressure control in HFpEF: Lessons from OPTIMIZE-HF

2019 ◽  
Vol 2019 (1) ◽  
Author(s):  
Mohamed Hassan
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Clinical Trial ◽  
Ejection Fraction ◽  
Observational Studies ◽  
Pressure Control ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Over Time

[first paragraph of article]Heart failure (HF) with preserved ejection fraction (HFpEF) represents approximately 50% of the world's HF population, and this proportion is increasing over time. The diagnosis of HFpEF is more challenging than HF with reduced ejection fraction (HFrEF). Patients with HFpEF are significantly older, more likely to be female, and more likely to have hypertension, obesity, anemia, atrial fibrillation, renal disease, and pulmonary disease compared to those with HFrEF. In observational studies, rates of hospitalization and death among patients with HFpEF approach those with HFrEF, however in clinical trial populations, outcomes are better in patients who have HFpEF. Death from non- cardiovascular causes is more common in patients who have HFpEF than in those with HFrEF, and a smaller percentage of patients with HFpEF die from CVD-related causes.

scholarly journals Real-world treatment switching to sacubitril/valsartan in patients with heart failure with reduced ejection fraction: A cohort study

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001305
Author(s):  
Sashiananthan Ganesananthan ◽  
Nisar Shah ◽  
Parin Shah ◽  
Hossam Elsayed ◽  
Julie Phillips ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Clinical Trial ◽  
Ejection Fraction ◽  
Real World ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Treatment Switching

BackgroundSacubitril/valsartan is an effective treatment for heart failure with reduced ejection fraction (HFrEF) based on clinical trial data. However, little is known about its use or impact in real-world practice. The aim of this study was to describe our routine clinical experience of switching otherwise optimally treated patients with HFrEF to sacubitril/valsartan with respect to patient outcomes such as quality of life (QoL) and echocardiographic variables.Methods and resultsFrom June 2017 to May 2019, 80 consecutive stable patients with HFrEF on established and maximally tolerated guideline-directed HF therapies were initiated on sacubitril/valsartan with bimonthly uptitration. Clinical assessment, biochemistry, echocardiography and QoL were compared pretreatment and post-treatment switching. We were able to successfully switch 89% of patients from renin–angiotensin axis inhibitors to sacubitril/valsartan (71 of 80 patients). After 3 months of switch therapy, we observed clinically significant and incremental improvements in blood pressure (systolic blood pressure 123 vs 112 mm Hg, p<0.001; diastolic blood pressure 72 vs 68 mm Hg, p=0.004), New York Heart Association functional classification score (2.3 vs 1.9, p<0.001), Minnesota Living with Heart Failure Questionnaire score (46 vs 38, p=0.016), left ventricular ejection fraction (26% vs 33%, p<0.001) and left ventricular end systolic diameter (5.2 vs 4.9 cm, p=0.013) compared with baseline. There were no significant changes in renal function or serum potassium.ConclusionThis study provides real-world clinical practice data demonstrating incremental improvements in functional and echocardiographic outcomes in optimally treated patients with HFrEF switched to sacubitril/valsartan. The data provide evidence beyond that observed in clinical trial settings of the potential benefits of sacubitril/valsartan when used as part of a multidisciplinary heart failure programme.

P6356Comparisons of clinical outcomes in patients with heart failure with preserved ejection fraction with and without atrial fibrillation: results from a multicenter PURSUIT-HFpEF registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Masuda ◽  
T Kanda ◽  
M Asai ◽  
T Mano ◽  
T Yamada ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients ◽  
Patients With Heart Failure

Abstract Background The presence of atrial fibrillation (AF) has been demonstrated to be associated with poor clinical outcomes in heart failure patients with reduced ejection fraction. Objective This study aimed to elucidate the impact of the presence of atrial fibrillation (AF) on the clinical characteristics, therapeutics, and outcomes in patients with heart failure and preserved ejection fraction (HFpEF). Methods PURSUIT-HFpEF is a multicenter prospective observational study including patients hospitalized for acute heart failure with left ventricular ejection fraction of >50%. Patients with acute coronary syndrome or severe valvular disease were excluded. Results Of 486 HFpEF patients (age, 80.8±9.0 years old; male, 47%) from 24 cardiovascular centers, 199 (41%) had AF on admission. Patients with AF had lower systolic blood pressures (142±27 vs. 155±35mmHg, p<0.0001) and higher heart rates (91±29 vs. 82±26bpm, p<0.0001) than those without. There was no difference in the usage of inotropes or mechanical ventilation between the 2 groups. A higher quality of life score (EQ5D, 0.72±0.27 vs. 0.63±0.30, p=0.002) was observed at discharge in patients with than without AF. In addition, AF patients tended to demonstrate lower in-hospital mortality rates (0.5% vs. 2.4%, p=0.09) and shorter hospital stays (20.3±12.1 vs. 22.6±18.4 days, p=0.09) than those without. During a mean follow up of 360±111 days, mortality (14.1% vs. 15.3) and heart failure re-hospitalization rates (13.1% vs. 13.9%) were comparable between the 2 groups. Conclusion In contrast to heart failure patients with reduced ejection fraction, AF on admission was not associated with poor long-term clinical outcomes among HFpEF patients. Several in-hospital outcomes were better in patients with AF than in those without. Acknowledgement/Funding None

P6257Low systolic blood pressure on admission as a predictor of outcome in octogenarian patients with heart failure and preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Tsuda ◽  
Y Kanzaki ◽  
D Maeda ◽  
K Akamatsu ◽  
S Nakayama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Cardiac Death ◽  
Preserved Ejection Fraction ◽  
Very Elderly ◽  
Patients With Heart Failure ◽  
Poor Outcomes

Abstract Background Heart failure (HF) is an epidemic in healthcare worldwide including Asia. It appears that HF will become more serious with aging of the population. The patients with heart failure and preserved ejection fraction (HFpEF) were older, more often female, and frequently have comorbidities including hypertension. However, lower systolic blood pressure (SBP) on admission is associated with poor outcomes in patients with HF. It remains unclear whether this association is similar in very elderly patients with HFpEF. Purpose To investigate clinical features and prognosis in octogenarian HFpEF subjects. Methods We analyzed 87 consecutive subjects aged 80 years or older who were hospitalized for acute decompensated HF with left ventricular ejection fraction (LVEF) ≥50% between 2015 and 2017. Clinical characteristics and a composite event of cardiac death and HF hospitalization were compared in two groups according to SBP cut-off of 140 mmHg on admission. Results The prevalence of lower SBP subjects (mean BP = 118 mmHg) and higher SBP (mean BP = 166 mmHg) subjects were 41.4% and 58.6%, respectively. Lower SBP subjects were more comorbid with atrial fibrillation (72.2 vs. 45.1%, p=0.01). In the lower SBP group, diuretics, mineralocorticoid receptor antagonists (MRA), beta-blockers and ACE inhibitors/ARBs were more commonly used than higher SBP group (Table). During the observational period (median = 1.0 year), lower SBP on admission was associated with a 2.65-fold [95% confidence interval (CI): 1.29–5.55, p=0.009] greater likelihood of experiencing the composite events of cardiac death and rehospitalization for HF (Figure). This observation was still consistent even after adjusting clinical demographics and comorbidity [hazard ratio = 2.95, 95% CI: 1.30–6.87, p=0.01]. Table 1 Lower SBP group (n=36) Higher SBP group (n=51) P-value Atrial fibrillation (%) 72.2 0.01 0.01 Loop diuretic (%) 97.1 83.7 0.08 MRA (%) 47.1 24.5 0.04 Beta-blocker (%) 52.9 44.9 0.51 ACE inhibitor/ARB (%) 59.2 29.4 0.01 Figure 1 Conclusions In octogenarian patients with acute decompensated HF and preserved LVEF, SBP on admission less than 140 mmHg is significantly associated with poor outcomes. Future studies need to prospectively evaluate optimal SBP treatment goals in very elderly patients with HFpEF.

Abstract 17148: Association of Atrial Fibrillation With Short-Term Outcomes in Patients Hospitalized for Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Srikanth Yandrapalli ◽  
Amole Ojo ◽  
Prakash Harikrishnan ◽  
Venkat L Vuddanda ◽  
Mohammed Karim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
The United States ◽  
Hospital Death ◽  
Preserved Ejection Fraction ◽  
Short Term ◽  
Reduced Ejection Fraction ◽  
Logistic Regression Models

Background: Atrial fibrillation (AF) is frequently present in patients with heart failure (HF) with preserved ejection fraction (HFpEF). The association of AF with short term outcomes in patients hospitalized for HFpEF is not well studied. Methods: We queried the United States Nationwide Readmissions Database year 2014 using appropriate ICD-9 codes to identify a weighted sample of adult patients hospitalized for HFpEF. Patients with concomitant diagnoses of HF with reduced ejection fraction (HFrEF) were excluded. The primary outcome was a composite of in-hospital death or a 30-day readmission for HF. Secondary outcomes studied were individual outcomes along with composites of in-hospital death or a 30-day readmission for any cause or cardiac etiologies. Survey specific adjusted multivariable logistic regression models were used to analyze the association of AF with outcomes. Results: Of 229,098 patients (mean age 76 years, 38% men) who were hospitalized for HFpEF during the study period, AF was present in 45.3% (N=103,852). Patients with AF were older (mean age 80 vs 72 years, p<.001) and more likely men (39% vs 37.5%, p<.001) compared to patients without AF. Primary outcome occurred in 9.5% patients with AF and in 8.0% patients without AF (p<0.001). After adjusting for patient demographics, comorbidities, complications, and hospital characteristics, AF was associated with 17% higher odds of the primary outcome (OR 1.17, 95% CI 1.11-1.23), 20% higher odds of in-hospital death (OR 1.20, 95% CI 1.07-1.34), and 17% higher odds of a 30-day readmission for HF (OR 1.17, 95% CI 1.10-1.25). Similar results were noted for other outcomes; TABLE . Conclusion: AF was associated with significantly worse short-term outcomes in patients hospitalized for HFpEF. Additional strategies are needed to improve outcomes in HFpEF patients with AF. Future prospective studies need to examine if AF ablation in HFpEF may improve outcomes as in HFrEF.

scholarly journals Blood Pressure and Safety Events With Vericiguat in the VICTORIA Trial

2021 ◽  
Author(s):  
Carolyn S. P. Lam ◽  
Hillary Mulder ◽  
Yuri Lopatin ◽  
Jose B. Vazquez‐Tanus ◽  
David Siu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Proportional Hazards ◽  
Study Drug ◽  
Cox Proportional Hazards ◽  
Angiotensin Receptor ◽  
Unique Identifier ◽  
Reduced Ejection Fraction ◽  
Over Time

Background Although safety and tolerability of vericiguat were established in the VICTORIA (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) trial in patients with heart failure with reduced ejection fraction, some subgroups may be more susceptible to symptomatic hypotension, such as older patients, those with lower baseline systolic blood pressure (SBP), or those concurrently taking angiotensin receptor neprilysin inhibitors. We described the SBP trajectories over time and compared the occurrence of symptomatic hypotension or syncope by treatment arm in potentially vulnerable subgroups in VICTORIA. We also evaluated the relation between the efficacy of vericiguat and baseline SBP. Methods and Results Among patients receiving at least 1 dose of the study drug (n=5034), potentially vulnerable subgroups were those >75 years old (n=1395), those with baseline SBP 100–110 mm Hg (n=1344), and those taking angiotensin receptor neprilysin inhibitors (n=730). SBP trajectory was plotted as mean change from baseline over time. The treatment effect on time to symptomatic hypotension or syncope was evaluated overall and by subgroup, and the primary efficacy composite outcome (heart failure hospitalization or cardiovascular death) across baseline SBP was examined using Cox proportional hazards models. SBP trajectories showed a small initial decline in SBP with vericiguat in those >75 years old (versus younger patients), as well as those receiving angiotensin receptor neprilysin inhibitors (versus none), with SBP returning to baseline thereafter. Patients with SBP <110 mm Hg at baseline showed a trend to increasing SBP over time, which was similar in both treatment arms. Safety event rates were generally low and similar between treatment arms within each subgroup. In Cox proportional hazards analysis, there were similar numbers of safety events with vericiguat versus placebo (adjusted hazard ratio [HR], 1.18; 95% CI, 0.99–1.39; P =0.059). No difference existed between treatment arms in landmark analysis beginning after the titration phase (ie, post 4 weeks) (adjusted HR, 1.14; 95% CI, 0.93–1.38; P =0.20). The benefit of vericiguat compared with placebo on the primary composite efficacy outcome was similar across the spectrum of baseline SBP ( P for interaction=0.32). Conclusions These data demonstrate the safety of vericiguat in a broad population of patients with worsening heart failure with reduced ejection fraction, even among those predisposed to hypotension. Vericiguat’s efficacy persisted regardless of baseline SBP. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02861534.

scholarly journals Tends in beta-blocker administration and in prevalence of indications for their usage in heart failure with preserved ejection fraction: an analysis of randomized clinical trials

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Kokhan ◽  
G Kiyakbaev ◽  
Z.H Kobalava
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Randomized Clinical Trials ◽  
The Other ◽  
Preserved Ejection Fraction ◽  
Over Time

Abstract Background Despite the lack of data supporting their benefits, beta-blockers (BBs) frequently prescribed for heart failure with preserved ejection fraction (HFpEF). This may be due to the other indications (coronary heart disease, atrial fibrillation, etc.) on the one hand and due to clinical inertia with translation evidence from heart failure with reduced ejection fraction to HFpEF on the other. Purpose To assess the trends in BBs administration and prevalence of the possible indications for their usage (hypertension, atrial fibrillation, coronary heart disease, myocardial infarction) in the participants of the randomized clinical trials (RCTs) of HFpEF. Methods A systematic literature search of PubMed database was performed. RCTs of pharmacological treatment of HFpEF carried out between 1993 and 2019 were used. Studies of the effectiveness of BBs usage, or studies performed in specific populations (HFpEF+coronary heart disease or HFpEF+hypertension, etc.) were excluded. Features at enrolment date and data on the frequency of BBs admission and the prevalence of hypertension, atrial fibrillation, coronary heart disease, and myocardial infarction were extracted. The trends over time of enrolment were analyzed using the Mann-Kendall test. Results Of the 718 filtered publications, 14 RCTs met the inclusion and exclusion criteria fully. In the most recent trials, up to 75–80% of patients received BBs. Time trends analysis revealed that between 1993–2019 years the frequency of BBs use among the participants of the RCTs of HFpEF significantly increased (tau=0.51, p=0.014). No such change was observed in the prevalence of coronary heart disease, myocardial infarction, hypertension, and atrial fibrillation (all p&gt;0.05). Prevalence of hypertension and atrial fibrillation showed a tendency toward increasing (tau=0.4, p=0.055 and tau=0.043, p=0.063, respectively) which became statistically significant for atrial fibrilation with the exclusion of the ALDO-DHF study (tau=0.5; p=0.042). The prevalence of myocardial infarction tended to decrease over time (tau=−0.73; p=0.06). Conclusion Over the last 20 years, the proportion of patients who used BB at enrolment in RCTs of HFpEF increased significantly. There was no statistically significant increase in the prevalence of the formal indications for their usage such as atrial fibrillation, hypertension, coronary heart disease or myocardial infarction. This fact requires attention since some retrospective studies have revealed that BBs use in HFpEF patients is associated with an increased risk of hospitalizations. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Mid- to Late-Life Time-Averaged Cumulative Blood Pressure and Late-Life Cardiac Structure, Function, and Heart Failure

Hypertension ◽  
2020 ◽  
Vol 76 (3) ◽  
pp. 808-818
Author(s):  
Kanako Teramoto ◽  
Wilson Nadruz Junior ◽  
Kunihiro Matsushita ◽  
Brian Claggett ◽  
Jenine E. John ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Specific Effect ◽  
Late Life ◽  
Left Ventricular ◽  
Observation Time ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction

Limited data exist regarding systolic blood pressure (SBP) through mid- to late-life and late-life cardiac function and heart failure (HF) risk. Among 4578 HF-free participants in the ARIC study (Atherosclerosis Risk in Communities) attending the fifth visit (2011–2013; age 75±5 years), time-averaged cumulative SBP was calculated as the sum of averaged SBPs from adjacent consecutive visits (visits 1–5) indexed to total observation time (24±1 years). Calculations were performed using measured SBPs and also incorporating antihypertensive medication specific effect constants (underlying SBP). Outcomes included comprehensive echocardiography at visit 5 and post-visit 5 incident HF, HF with preserved ejection fraction, and reduced ejection fraction. Higher cumulative SBP was associated with greater left ventricular mass and worse diastolic measures (all P <0.001), associations that were stronger with underlying compared with cumulative SBP (all P <0.05). At 5.6±1.2 years follow-up post-visit 5, higher cumulative measured and underlying SBP were associated with incident HF (hazard ratio per 10 mm Hg for measured: 1.12 [1.01–1.24]; underlying: 1.19 [95% CI, 1.10–1.30]) and HF with preserved ejection fraction (measured: 1.15 [1.00–1.33]; underlying: 1.28 [1.14–1.45]), but not HF with reduced ejection fraction (measured: 1.11 [0.94–1.32]; underlying: 1.11 [0.96–1.24]). Associations with HF and HF with preserved ejection fraction were more robust with cumulative underlying compared with measured SBP (all P <0.05). Time-averaged cumulative SBP in mid to late life is associated with worse cardiac function and risk of incident HF, especially HF with preserved ejection fraction, in late life. These associations were stronger considering underlying as opposed to measured SBP, highlighting the importance of prevention and effective treatment of hypertension to prevent late-life cardiac dysfunction and HF.

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