Education as a Heart Failure Intervention: What ProvidersTaught Patients in One Hospital Setting

Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly.

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A Systematic Review on the Use of Sacubitril/Valsartan Initiated Prior to Discharge in Hospitalized Patients With Heart Failure

Annals of Pharmacotherapy ◽

10.1177/1060028020943940 ◽

2020 ◽

pp. 106002802094394

Author(s):

Krisy-Ann Thornby ◽

Nicole M. Maksutovic

Keyword(s):

Heart Failure ◽

Functional Capacity ◽

Acute Decompensated Heart Failure ◽

Data Extraction ◽

Hospital Setting ◽

Decompensated Heart Failure ◽

Patient Specific ◽

Study Selection ◽

Patients With Heart Failure ◽

Specific Factors

Objective: Systematically review the evidence of sacubitril/valsartan initiated in the hospital setting prior to discharge in patients with acute decompensated heart failure (HF). Data Sources: A literature search using keywords related to sacubitril/valsartan, HF, and inpatient use was performed using MEDLINE, CINAHL, and Google Scholar from inception through May 8, 2020. Study Selection and Data Extraction: Eligible studies included patients initiated on sacubitril/valsartan while inpatient and reported efficacy and safety outcomes. Data Synthesis: A total of 10 articles were included for study review, of which 9 were full text and 1 was a conference poster. Key outcomes of interest were related to tolerability, N-terminal proB-type natriuretic peptide (NT-proBNP), functional capacity, target dose attainment, or rehospitalization rates. NT-proBNP levels were improved in 4 trials, and the results of functional capacity were mixed based on 2 studies. Rehospitalization rates were reported as secondary outcomes, and only 1 large study showed numerical and statistical improvement. The most frequent dose initiated prior to discharge was sacubitril/valsartan 24/26 mg twice daily. Hypotension was the most commonly reported adverse drug reaction and was commonly cited as a reason for not tolerating inpatient initiation with sacubitril/valsartan therapy. Relevance to Patient Care and Clinical Practice: Inpatient initiation of sacubitril/valsartan may improve surrogate and clinical outcomes after hemodynamic stabilization. Clinicians should consider patient-specific factors to ensure that benefits outweigh the risks and monitor for hypotension when initiated prior to hospital discharge. Conclusion: Initiating inpatient treatment with sacubitril/valsartan after hemodynamic stabilization is reasonable based on available evidence.

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