scholarly journals Clinical Profile of Patients with Heart Failure in Eastern Part of Nepal: a Hospital based study

2019 ◽  
Vol 8 (1) ◽  
pp. 48-52
Author(s):  
Abdul Khaliq Monib ◽  
Sahadeb Prasad Dhungana ◽  
Rajesh Nepal ◽  
Rinku Ghimire
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Angiotensin Receptor Blockers ◽  
Hypertensive Heart Disease ◽  
College Teaching ◽  
Clinical Profile ◽  
Female Ratio ◽  
Coronary Syndrome ◽  
Patients With Heart Failure ◽  
Receptor Blockers

Background: There is limited information on the clinical profile of patients with heart failure from the Nepalese population. Materials and Methods: This is a descriptive cross-sectional study on 120 consecutive patients with New York Heart Association class II or IV symptoms of heart failure admitted from June 2018 to January 2019 at Nobel Medical College Teaching hospital, Biratnagar, Nepal. Results: Mean age was 52.2 ± 20.6 years. The male and female ratio was 0.71. Ischemic cardiomyopathy, rheumatic heart disease, dilated cardiomyopathy, acute coronary syndrome, hypertensive heart disease, and peripartum cardiomyopathy were common etiologies constituting 22.5%, 19.1%,13.3%, 9.1%, 8.3 %, 5% of cases respectively. Among co-morbid conditions, anemia (91.6%),hypertension (31.6%), coronary artery disease (29.1%), diabetes (20.8%) and chronic kidney disease (11.6%) were common. Among various drugs used, 66.6% patients were prescribed diuretics, 60% mineral corticoid receptor blockers, 33.3% angiotensin-converting enzymeinhibitors, 33.3% beta-blockers, 29.1% digoxin and 8.3% angiotensin receptor blockers. Echocardiography revealed LV systolic and diastolic dysfunction in 75% and 25% respectively, mitral regurgitation in 52.5%, right ventricular dysfunction in 10.8 % and pulmonary artery hypertension in 66.6%. Conclusion: Appropriate use of evidence-based therapies, careful attention to the diagnosis and management of specific co-morbidities in patients with HF may help to improve outcomes.

scholarly journals Evaluation of drugs used in chronic heart failure at tertiary care centre: a hospital based study

2019 ◽  
Vol 11 (2) ◽  
pp. 79-84 ◽  
Author(s):  
Rinku Ghimire ◽  
Sahadeb Prasad Dhungana
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Nyha Class ◽  
Tertiary Care ◽  
Hypertensive Heart Disease ◽  
College Teaching ◽  
Tertiary Care Centre

Introduction: There is lack of data on pattern of use of drugs in patients with chronic heart failure (CHF) from Nepalese population. This study was conducted to explore the trends of evidence based medications used for CHF in our population. Methods: This is a cross-sectional study on 200 consecutive patients with New York Heart Association (NYHA) class II to IV symptoms of CHF who attended cardiology clinic or admitted from September 2017 to August 2018 at Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Results: Mean age of patients was 54 (range 15-90) years. Ischemic cardiomyopathy, rheumatic heart disease, dilated cardiomyopathy, hypertensive heart disease, peripartum cardiomyopathy were common etiologies of CHF. Analysis of drugs used in CHF revealed that 85% patients were prescribed diuretics, 58.5% angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 53% mineralocorticoid receptor antagonists (MRAs), 38% beta-blockers (BBs) and 24% digoxin. Digoxin was mainly used as add on therapy for patients with atrial fibrillation (24% of all patients). Antithrombotics (warfarin or aspirin), inotropic agents (dopamine, dobutamine or noradrenaline), antiarrhythmic agent (amiodarone) and nitrates (intravenous glyceryl trinitrate or oral isosorbide dinitrate) were prescribed for 48%, 28%, 5% and 6% patients respectively. All CHF patients with preserved or mid-range ejection fraction (25% of all patients) were prescribed diuretics along with antihypertensive drugs for hypertensive patients. Conclusion: CHF is associated with significant morbidity and mortality due to associated co-morbidities and underuse of proven therapy like BBs, ACEIs or ARBs and MRAs. Careful attention to optimization of different drugs therapy in patients with CHF may help to improve patient outcomes.

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.

scholarly journals The Effect of Digoxin on Renal Function in Patients with Heart Failure

2021 ◽  
Author(s):  
Ian Hanning ◽  
Pierpaolo Pellicori ◽  
Jufen Zhang ◽  
Sunil Bhandari ◽  
Andrew Clark ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Enzyme Inhibitor ◽  
Angiotensin Receptor Blockers ◽  
Rate Of Change ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
Before And After ◽  
Receptor Blockers ◽  
Rate Of Decline

Abstract Introduction: Digoxin is used in patients with chronic heart failure (CHF) who remain symptomatic despite optimal medical treatment. Impaired renal function is commonly associated with CHF. We investigated the relation between digoxin use and change in renal function over time in patients with CHF. Methods: 1241 patients with symptoms and signs of CHF (average age 72 years (64% male), and median NTproBNP 1426 ng/l (interquartile range 632 - 2897) were divided into four groups: never on digoxin (N=394); digoxin throughout (N= 449); started digoxin at some point after baseline (N=367); and stopped digoxin at some point after baseline (N= 31). The rate of change of estimated glomerular filtration rate (eGFR) was calculated using linear regression. Results: Patients on digoxin throughout had a significantly greater rate of decline in eGFR per year than patients not on digoxin throughout (mean (± standard deviation); -5 (13) ml/min/1.73m2 per year v -2 (10) ml/min/1.73m2 per year, P= 0.02). In those patients who started digoxin during follow up, there was no significant difference in the rate of decline in eGFR before and after starting digoxin. There was no correlation between baseline eGFR (or rate of decline in eGFR) and age, haemoglobin or NTproBNP. Compared to patients taking both angiotensin-converting-enzyme inhibitor (ACEi) or angiotensin receptor blockers (ARB) and beta-blocker (BB), patients who were not taking an ACEi/ARB or BB had a numerically faster rate of decline in eGFR, although this was not statistically significant.Conclusion: The rate of decline in renal function is greater in patients with CHF who are taking digoxin.

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.

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