scholarly journals Management of Heart Failure Patient with CKD

2021 ◽  
pp. CJN.14180920
Author(s):  
Debasish Banerjee ◽  
Giuseppe Rosano ◽  
Charles A. Herzog
Keyword(s):  
Heart Failure ◽  
Angiotensin Receptor Blockers ◽  
Inhibitor Therapy ◽  
High Dose ◽  
Evidence Based ◽  
Angiotensin Receptor ◽  
Sodium Glucose Cotransporter ◽  
Ckd Stage ◽  
Patients With Heart Failure ◽  
Receptor Blockers

CKD is common in patients with heart failure, associated with high mortality and morbidity, which is even higher in people undergoing long-term dialysis. Despite increasing use of evidence-based drug and device therapy in patients with heart failure in the general population, patients with CKD have not benefitted. This review discusses prevalence and evidence of kidney replacement, device, and drug therapies for heart failure in CKD. Evidence for treatment with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and sodium-glucose cotransporter inhibitors in mild-to-moderate CKD has emerged from general population studies in patients with heart failure with reduced ejection fraction (HFrEF). β-Blockers have been shown to improve outcomes in patients with HFrEF in all stages of CKD, including patients on dialysis. However, studies of HFrEF selected patients with creatinine <2.5 mg/dl for ACE inhibitors, <3.0 mg/dl for angiotensin-receptor blockers, and <2.5 mg/dl for mineralocorticoid receptor antagonists, excluding patients with severe CKD. Angiotensin receptor neprilysin inhibitor therapy was successfully used in randomized trials in patients with eGFR as low as 20 ml/min per 1.73 m2. Hence, the benefits of renin-angiotensin-aldosterone axis inhibitor therapy in patients with mild-to-moderate CKD have been demonstrated, yet such therapy is not used in all suitable patients because of fear of hyperkalemia and worsening kidney function. Sodium-glucose cotransporter inhibitor therapy improved mortality and hospitalization in patients with HFrEF and CKD stages 3 and 4 (eGFR>20 ml/min per 1.73 m2). High-dose and combination diuretic therapy, often necessary, may be complicated with worsening kidney function and electrolyte imbalances, but has been used successfully in patients with CKD stages 3 and 4. Intravenous iron improved symptoms in patients with heart failure and CKD stage 3; and high-dose iron reduced heart failure hospitalizations by 44% in patients on dialysis. Cardiac resynchronization therapy reduced death and hospitalizations in patients with heart failure and CKD stage 3. Peritoneal dialysis in patients with symptomatic fluid overload improved symptoms and prevented hospital admissions. Evidence suggests that combined cardiology-nephrology clinics may help improve management of patients with HFrEF and CKD. A multidisciplinary approach may be necessary for implementation of evidence-based therapy.

Abstract 343: Trends and Predictors of Use of Angiotensin Receptor Blocker and Neprilysin Inhibitor in Patients With Heart Failure

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Supriya Shore ◽  
Tanima Basu ◽  
Neil Kamdar ◽  
Patrick Brady ◽  
Scott L Hummel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
Patients With Heart Failure ◽  
Receptor Blockers

Objective: Current guidelines recommend use of combination therapy with angiotensin receptor blocker and neprilysin inhibitor (ARNI) (i.e., Entresto ® ) in patients with heart failure (HF) with reduced ejection fraction as a class 1 recommendation. Contemporary data on real-world use of these agents is lacking. Methods: This is a retrospective cohort study of individuals enrolled in Clinformatics® Data Mart Database (OptumInsight, Eden Prairie, MN from January 1, 2016 to December 31, 2018. We included all individuals ≥ 18 years, with two outpatient encounters or one inpatient encounter with a principal ICD 10 diagnosis for HFand 6 months of continuous enrollment. To further identify patients with reduced ejection fraction, we only included individuals who received prescriptions for beta-blockers and angiotensin converting enzyme inhibitors/ angiotensin receptor blockers. Comorbidities were identified using Elixhauser comorbidity index.. Multivariate logistic regression model was used to identify predictors of ARNI use. Results: A total of 154,777 patients were included in our cohort. Overall, 5,834 patients (3.8%) received an ARNI prescription. Use of ARNI increased from 1.4% in 2016 to 3.9% in 2018 (p<0.01). Compared to patients receiving angiotensin converting enzyme inhibitors/angiotensin receptor blockers, patients receiving ARNI were younger (mean age 69.4 ± 11.1 vs. 72.9 ± 11.0 years;), more likely to be male (69.3% vs. 54.4%) and have commercial insurance (22.1% vs. 16.7%) with a higher comorbidity burden. Predictors of ARNI use after multivariable adjustment included age<65 years (OR 1.4; 95% CI 1.3-1.5), Male sex (OR 1.8; 95% CI 1.7 - 1.9) and black race (OR 1.2; 95% CI 1.1 - 1.2). Other predictors of ARNI use are shown in Figure 1. Patients receiving care through a cardiologist compared to a primary care physician were more likely to receive an ARNI (OR 1.8; 95% 1.7 - 1.9). Out of pocket cost for ARNI ranged from $0 to $1006 per month (median $44; IQR $9-$60). Conclusion: Rates of ARNI use remain low among patients with heart failure with racial and gender disparities. Heart Failure patients receiving care with a cardiologist were more likely to receive ARNI. Out of pocket cost for this medication remains high and may be a significant barrier to its use.

Abstract 3110: Adherence to Beta-blockers and ACE Inhibitors/Angiotensin Receptor Blockers in the First Year after Diagnosis of Heart Failure: 10 Year Observational Trends

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Darcy A Lamb ◽  
Dean T Eurich ◽  
Finlay A McAlister ◽  
Ross Tsuyuki ◽  
William M Semchuk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Administrative Databases ◽  
First Year ◽  
Angiotensin Receptor ◽  
Patients With Heart Failure ◽  
Receptor Blockers ◽  
One Year ◽  
Optimal Adherence

Introduction: As prescriptions for evidence based medications in patients with heart failure (HF) have increased over the past 10 years, we aimed to determine if adherence to HF medications has also increased over this time. Methods: A retrospective cohort was created using administrative databases from the province of Saskatchewan, Canada. Subjects discharged alive from their first hospitalization for HF between 1994 and 2003 were eligible for study. Those filling a prescription for a beta blocker (BB), ACE inhibitor (ACEI), or angiotensin receptor blocker (ARB) within six months after discharge were selected. The proportion of subjects with optimal 1-year adherence (≥ 80%) was determined and divided according to the year of entry into the study. Results: Of 8,805 eligible patients, 67% of BB users (941/1414) and 74% of ACEI/ARB users (4441/5991) exhibited 1-year adherence ≥ 80%. When grouped by year of initial HF hospitalization, the proportion of patients with optimal 1-year adherence improved from 54% to 75% with BB and from 67% to 80% with ACEI/ARBs between 1994/95 and 2002/03 [Figure ]. Mean 1-year adherence improved from 71% to 83% and 80% to 88% for BB and ACEI/ARBs, respectively. After covariate adjustment using multivariate logistic regression, year of initial HF hospitalization remained independently associated with optimal 1-year adherence. Subjects discharged in 2003 were significantly more likely to exhibit optimal adherence to a BB (OR 2.04; 95% CI 1.21–3.44) or an ACEI/ARB (OR 1.65; 95% CI 1.30–2.08) than those prescribed therapy in 1994/95. Conclusion: One year adherence to BB and ACEI/ARB is improving over time in patients newly diagnosed with HF.

scholarly journals ANEMIA PADA GAGAL JANTUNG

2013 ◽  
Vol 2 (3) ◽  
Author(s):  
Cecilia Hendrata ◽  
Reginald L. Lefrandt
Keyword(s):  
Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Patients With Heart Failure ◽  
Receptor Blockers

Abstract: Anemia, a frequently occuring comorbid in patients with heart failure, is increasingly recognized as an independent predictor of morbidity and mortality. The etiology of anemia associated with heart failure is not entirely understood. It is assumed as a multifactorial anemia, most likely caused by chronic kidney diseases and other chronic diseases. Besides that, iron deficiency due to lack of iron intake and absorption, and chronic blood loss due to anti-platelet agents play some important roles, too. Other factors related to risks of anemia in heart failure are old age, female gender, decrease of body mass index, usage of angiotensin converting enzyme inhibitors (ACE-inhibitors) and angiotensin receptor blockers (ARBs), and advanced heart failure.  Based on its documented impact on clinical outcomes, anemia has emerged as a possible target for treatment in patients with heart failure. Further studies are needed to determine the optimal threshold for initiation of treatment, target hemoglobin, optimum dosing regimen, choices of erythropoietic agents, roles of iron suplementation, and long-term safety of erythropoietic agents in anemic patients with heart failures. Key words: anemia, heart failure, management, therapy.     Abstrak: Anemia merupakan komorbid yang sering ditemukan pada penderita gagal jantung dan telah dikenal sebagai prediktor independen dari morbiditas dan mortalitas. Penyebab anemia yang menyertai gagal jantung tidak sepenuhnya diketahui, diduga sebagai anemia multifaktor yang umumnya diakibatkan oleh gagal ginjal kronis dan penyakit kronis lainnya. Selain itu defisiensi besi akibat kurangnya asupan maupun absorbsi besi, serta kehilangan darah kronik akibat konsumsi obat-obatan anti platelet turut berperan. Faktor lainnya yang berhubungan dengan resiko terjadinya anemia pada gagal jantung adalah: usia tua, jenis kelamin perempuan, adanya  penurunan indeks massa tubuh, penggunaan obat-obat angiotensin converting enzyme inhibitors (ACE-inhibitors) dan angiotensin receptor blockers (ARBs), serta gagal jantung tingkat lanjut. Berdasarkan dampaknya terhadap hasil klinis, anemia perlu dipikirkan sebagai target pengobatan pada penderita gagal jantung. Studi lanjut diperlukan untuk menentukan ambang optimal untuk memulai pengobatan anemia, hemoglobin target, regimen dosis yang optimum, pemilihan preparat eritropoietik, peran suplementasi besi, dan keamanan pemberian jangka panjang preparat eritropoietik pada penderita anemia dengan gagal jantung. Kata kunci: anemia, gagal jantung, penanganan, pengobatan.

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