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.

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 &gt;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.

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