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Guidelines for HFrEF treatment

Muthiah Vaduganathan, Akshay S Desai
Composite angiotensin receptor-neprilysin inhibition (ARNi) represents a novel pharmacologic strategy for treatment of heart failure with reduced ejection fraction (HFrEF). In the PARADIGM-HF (Prospective comparison of ARNi with ACEi to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial of 8399 subjects with HFrEF, treatment with the ARNi LCZ696 (sacubitril/valsartan) was associated with statistically important reductions in cardiovascular death, all-cause mortality, and the composite of cardiovascular death or heart failure hospitalization in comparison with enalapril...
November 2016: Current Cardiology Reports
Martin M LeWinter, Michael R Zile
No abstract text is available yet for this article.
October 11, 2016: Circulation
Ward A Heggermont, Marc Goethals, Riet Dierckx, Sofie Verstreken, Jozef Bartunek, Marc Vanderheyden
The brand new 2016 ESC guidelines for the treatment of acute and chronic heart failure continue to give a prominent place to mineralocorticoid receptor antagonists in the treatment of chronic heart failure with reduced ejection fraction (HFrEF). In the prevention of HF hospitalization and death, a class I, level of recommendation A, is given to MRAs for patients with HFrEF, who remain symptomatic despite treatment with an ACE-inhibitor and a beta-blocker and have an LVEF below 35 %. This recommendation is primarily based on two landmark trials, the RALES trial (for spironolactone) and the EMPHASIS-HF trial (for eplerenone)...
September 12, 2016: Heart Failure Reviews
Dimitrios Farmakis, Vassiliki Bistola, Apostolos Karavidas, John Parissis
The combination of neprilysin inhibitor sacubitril with the angiotensin II receptor 1 blocker valsartan is the first agent from the angiotensin receptor neprilysin inhibitors (ARNI) class authorized for clinical use in heart failure (HF) patients with reduced ejection fraction (HFrEF). Sacubitril/valsartan resulted in 20% reduction in the incidence rate of death or HF hospitalization compared to enalapril in symptomatic HFrEF patients in the seminal PARADIGM-HF trial. As a result, the recently updated European and American HF guidelines granted this agent a class IB indication for the treatment of ambulatory/chronic symptomatic HFrEF patients...
November 15, 2016: International Journal of Cardiology
Stuart B Prenner, Sanjiv J Shah, Clyde W Yancy
PURPOSE OF REVIEW: Numerous evidence-based medical and device therapies proven to reduce morbidity and mortality have advanced care for heart failure with reduced ejection fraction (HFrEF). The primacy of this approach has now been superseded by striking new data resulting in the approval of the combination of valsartan and sacubitril, a neprilysin inhibitor (also known as LCZ696), in 2015 for the treatment of HFrEF. LCZ696 is a novel heart failure drug that simultaneously inhibits the renin-angiotensin system and potentiates the natriuretic peptide system...
August 2016: Current Atherosclerosis Reports
Elaine Nguyen, Erin R Weeda, C Michael White
Heart failure (HF) impacts an estimated 5.7 million Americans, and its prevalence is projected to increase to more than 8 million Americans in the next 15 years. Key clinical trials have established an evidence-based foundation for treatment of heart failure with reduced ejection fraction (HFrEF). Ivabradine and sacubitril/valsartan, which inhibit the f-channel and the angiotensin receptor and neprilysin, respectively, were recently approved by the Food and Drug Administration for HFrEF. In systolic heart failure, treatment with the If inhibitor ivabradine significantly reduced the combined endpoint of cardiovascular mortality or heart failure hospital admission vs placebo (P < ...
August 2016: Journal of Clinical Pharmacology
Frederik H Verbrugge, Jeroen Vrijsen, Jan Vercammen, Lars Grieten, Matthias Dupont, Wilfried Mullens
OBJECTIVE: Beta blockers reduce all-cause mortality and readmissions in heart failure with reduced ejection fraction (HFrEF), which may be explained by their effect on heart rate (HR). This study assessed the impact of HR reduction with beta blockers on exercise capacity in recent onset HFrEF. METHODS AND RESULTS: Fifty consecutive patients with recent onset HFrEF (<30 days) performed a standardized exercise protocol with respiratory gas analysis at baseline as well as after 6 and 12 months...
October 2015: Acta Cardiologica
Eric Black-Maier, Benjamin A Steinberg, Jonathan P Piccini
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and it increases the risk of thromboembolic stroke and death. AF is common in patients with heart failure and reduced ejection fraction (HFrEF), affecting between 30 and 40% of patients with HFrEF. AF increases the risk of death and hospitalization in patients with HFrEF. Only two antiarrhythmic drugs (amiodarone and dofetilide) are guideline-recommended in patients with AF and heart failure (HF). Meta-analyses of studies of major trials in HF suggest that patients with AF/HFrEF do not benefit from conventional β-blockers...
June 2015: Expert Review of Cardiovascular Therapy
Petar M Seferović, Walter J Paulus
Diabetes mellitus-related cardiomyopathy (DMCMP) was originally described as a dilated phenotype with eccentric left ventricular (LV) remodelling and systolic LV dysfunction. Recently however, clinical studies on DMCMP mainly describe a restrictive phenotype with concentric LV remodelling and diastolic LV dysfunction. Both phenotypes are not successive stages of DMCMP but evolve independently to respectively heart failure with preserved left ventricular ejection fraction (HFPEF) or reduced left ventricular ejection fraction (HFREF)...
July 14, 2015: European Heart Journal
Edward Koifman, Ehud Grossman, Avishay Elis, Dror Dicker, Bella Koifman, Morris Mosseri, Rafael Kuperstein, Ilan Goldenberg, Tamir Kamerman, Nava Levine-Tiefenbrun, Robert Klempfner
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) comprises a large portion of heart failure patients and portends poor prognosis with similar outcome to heart failure with reduced ejection fraction (HFrEF). Thus far, no medical therapy has been shown to improve clinical outcome in this common condition. TRIAL DESIGN: The study is a randomized-controlled, multicenter clinical trial aimed to determine whether early posthospitalization comprehensive cardiac rehabilitation (CR) including exercise training (ET) in recently hospitalized HFpEF patients reduces the composite end point of all-cause mortality and hospitalizations in comparison with usual care (UC)...
December 2014: American Heart Journal
Brent N Reed, Jo E Rodgers, Carla A Sueta
Polypharmacy, the use of 4 or more medications, is universal in patients with heart failure (HF). Evidence-based combination therapy is prescribed in patients with HF with reduced ejection fraction (HFrEF). Additionally, treatment of the high prevalence of comorbidities presents many therapeutic dilemmas. The use of nonprescription medications is common, adding further complexity to the medication therapy regimens of patients with HF. An approach for combining evidence-based therapies in patients with HFrEF is presented...
October 2014: Heart Failure Clinics
Boback Ziaeian, Yan Zhang, Nancy M Albert, Anne B Curtis, Mihai Gheorghiade, J Thomas Heywood, Mandeep R Mehra, Christopher M O'Connor, Dwight Reynolds, Mary Norine Walsh, Clyde W Yancy, Gregg C Fonarow
BACKGROUND: Clinical trials have demonstrated benefit for cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) therapies in patients with heart failure with reduced ejection fraction (HFrEF); yet, questions have been raised with regard to the benefit of device therapy for minorities. OBJECTIVES: The purpose of this study was to determine the clinical effectiveness of CRT and ICD therapies as a function of race/ethnicity in outpatients with HFrEF (ejection fraction ≤35%)...
August 26, 2014: Journal of the American College of Cardiology
Kanan Patel, Gregg C Fonarow, O James Ekundayo, Inmaculada B Aban, Meredith L Kilgore, Thomas E Love, Dalane W Kitzman, Mihai Gheorghiade, Richard M Allman, Ali Ahmed
BACKGROUND: We examined the clinical effectiveness of beta-blockers considered evidenced-based to heart failure and reduced ejection fraction (HFrEF) and their recommended target doses in older adults with HF and preserved ejection fraction (HFpEF). METHODS: In OPTIMIZE-HF (2003-2004) linked to Medicare (2003-2008), of the 10,570 older (age ≥ 65 years, mean, 81 years) adults with HFpEF (EF ≥ 40%, mean 55%), 8373 had no contraindications to beta-blocker therapy...
May 15, 2014: International Journal of Cardiology
Rene Quiroz, Gheorghe Doros, Peter Shaw, Chang-Seng Liang, Diane F Gauthier, Flora Sam
Despite significant advances in therapies for patients with heart failure with reduced ejection fraction (HFrEF), there are no evidence-based therapies for heart failure with preserved ejection fraction (HFpEF), also known as diastolic heart failure (HF). Differences in pathophysiologic mechanisms are touted as to why patients with HFpEF purportedly do not derive similar therapeutic benefits compared with HFrEF. Similarly, the relative frequencies of HFpEF and HFrEF may differ between hospitalized and ambulatory settings...
February 15, 2014: American Journal of Cardiology
Frederik H Verbrugge, Jürgen Duchenne, Philippe B Bertrand, Matthias Dupont, W H Wilson Tang, Wilfried Mullens
In ambulatory patients with heart failure (HF) and reduced ejection fraction (rEF), renin-angiotensin system (RAS) and β-blockers at guideline-recommended target dose reduce all-cause mortality and readmissions. Benefits in HF with preserved ejection fraction (pEF), as well as uptitration after a hospitalization, remain uncertain. This study assesses the impact of RAS- and β-blocker uptitrations in patients with HFrEF versus HFpEF during and immediately after a hospital admission. In consecutive patients (209 HFrEF with left ventricular ejection fraction <40% and 108 HFpEF with left ventricular ejection fraction ≥40%), RAS- and β-blocker dose changes were followed during 6 months after an index HF hospitalization...
December 15, 2013: American Journal of Cardiology
Yu Xu, Yanan Shi, Zhongyu Zhu, Changhe Cui, Bei Li, Fang Chen, Dan Li, Songhu Chen, Yang Guo
The present study aimed to investigate the 5-year survival and medication status of patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF) in China. This study is a single-center, retrospective study and patients with HF and a left ventricular ejection fraction (LVEF) of ≤45%, were consecutively enrolled. The study population of 685 patients was divided into two groups, namely, LVEF ≤35 (n=371) and LVEF 36-45% (n=314). The patients were followed up for a median of 31 months (range, 8-61 months) and during this period, 24% of patients receiving angiotension-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) treatment and 23% of those receiving β-blockers reached the maximum tolerated dose...
December 2013: Experimental and Therapeutic Medicine
Brent N Reed, Carla A Sueta
This review will outline the management of patients with symptomatic systolic heart failure or heart failure with reduced ejection fraction (HFrEF), i.e., those with structural heart disease and previous or current symptoms. Determination of volume status and appropriate diuretic administration is important in heart failure management. Inhibition of the renin-angiotensin-aldosterone and sympathetic nervous systems improves survival and decreases hospitalizations in patients with systolic or reduced ejection fraction HF (HFrEF)...
2015: Current Cardiology Reviews
Harsh B Golwala, Udho Thadani, Li Liang, Stavros Stavrakis, Javed Butler, Clyde W Yancy, Deepak L Bhatt, Adrian F Hernandez, Gregg C Fonarow
BACKGROUND: Hydralazine-isosorbide dinitrate (H-ISDN) therapy is recommended for African American patients with moderate to severe heart failure with reduced ejection fraction (<40%) (HFrEF), but use, temporal trends, and clinical characteristics associated with H-ISDN therapy in clinical practice are unknown. METHODS AND RESULTS: An observational analysis of 54 622 patients admitted with HFrEF and discharged home from 207 hospitals participating in the Get With The Guidelines-Heart Failure registry from April 2008 to March 2012 was conducted to assess prescription, trends, and predictors of use of H-ISDN among eligible patients...
August 2013: Journal of the American Heart Association
Gaurav Banka, Paul A Heidenreich, Gregg C Fonarow
OBJECTIVES: This study sought to quantify the incremental cost-effectiveness ratios (ICER) of angiotensin-converting enzyme inhibitor (ACEI), beta-blocker (BB), and aldosterone antagonist (AldA) therapies for patients with heart failure with reduced ejection fraction (HFrEF). BACKGROUND: There are evidence-based, guideline-directed medical therapies for patients with HFrEF, but the incremental cost-effectiveness of these therapies has not been well studied using contemporary data...
April 2, 2013: Journal of the American College of Cardiology
Peter Rickenbacher
Based on multiple randomized controlled trials performed in the last 20 years, drugs form the basis of treatment for heart failure with reduced ejection fraction (HFREF). Despite solid evidence for their efficacy and safety and publication of detailed national and international guidelines many patients with HFREF remain, who are not at all or only insufficiently treated. Treatment goals include reduction of mortality and hospitalizations, improvement of symptoms and exercise tolerance as well as prevention of disease progression...
February 2011: Therapeutische Umschau. Revue Thérapeutique
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