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Guidelines for HFrEF treatment

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https://www.readbyqxmd.com/read/29305071/effectiveness-of-guideline-consistent-heart-failure-drug-prescriptions-at-hospital-discharge-on-1-year-mortality-results-from-the-epical2-cohort-study
#1
Amandine Busson, Nathalie Thilly, Hervé Laborde-Castérot, François Alla, Ziyad Messikh, Isabelle Clerc-Urmes, Alexandre Mebazaa, Marc Soudant, Nelly Agrinier
BACKGROUND: We aimed to assess the effectiveness of recommended drug prescriptions at hospital discharge on 1-year mortality in patients with heart failure (HF) and reduced ejection fraction (HFREF). MATERIALS AND METHODS: We used data from the EPICAL2 cohort study. HF patients ≥18years old with left ventricular ejection fraction (LVEF) <40% and alive at discharge were included and followed up for mortality. Socio-demographic, clinical and therapeutic data were collected at admission...
January 2, 2018: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29232274/from-theory-to-practice-the-diuretic-potential-of-sacubitril-valsartan-a-tale-of-2-patients
#2
Sabrina M Hormann, Lindsay E Davis, Elizabeth K Pogge
BACKGROUND: Heart failure prevalence continues to rise in the United States causing significant morbidity and mortality and costing billions in healthcare expenditures. Consensus guidelines updated in 2016 recommend an angiotensin receptor-neprilysin inhibitor (ARNi) as a therapeutic option in lieu of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for the management of stage C heart failure with reduced ejection fraction (HFrEF). For chronic HFrEF patients with New York Heart Association class II or III symptoms tolerating an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, a change in therapy to an ARNi is recommended to further reduce morbidity and mortality...
December 11, 2017: Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29192956/initial-clinical-experience-with-the-first-drug-sacubitril-valsartan-in-a-new-class-arnis-in-patients-with-heart-failure-with-reduced-left-ventricular-ejection-fraction-in-poland
#3
Marta Kałużna-Oleksy, Jolanta Kolasa, Jacek Migaj, Agnieszka Pawlak, Małgorzata Lelonek, Jadwiga Nessler, Ewa Straburzyńska-Migaj
Sacubitril/valsartan is the first drug from a new class of angiotensin receptor neprilisin inhibitors (ARNIs) recommended in the new European Society of Cardiology's guidelines instead of ACEIs, or ARBs (angiotensin receptor antagonists) used if ACEIs are not tolerated, for further reduction in the risk of hospitalisation or death in outpatients with HFrEF if symptoms continue despite optimal treatment with ACEIs/ARBs, betablockers and MRAs (mineralocorticoid antagonists). The aim of this paper is to present the initial experience with regard to the effectiveness, tolerance and safety of sacubitril/valsartan in the outpatient cardiology practice in Poland...
December 1, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/29181610/barriers-to-beta-blocker-use-and-up-titration-among-patients-with-heart-failure-with-reduced-ejection-fraction
#4
Emily B Levitan, Melissa K Van Dyke, Matthew Shane Loop, Ronan O'Beirne, Monika M Safford
PURPOSE: For patients with heart failure with reduced ejection fraction (HFrEF), guidelines recommend use of beta-blockers with gradual up-titration. However, many patients with HFrEF do not use beta-blockers and up-titration is rare. Our purpose was to identify and rank barriers to beta-blocker use and up-titration from the perspective of primary care physicians. METHODS: We conducted 4 moderated, structured group discussions among 19 primary care physicians using the nominal group technique; 16 participants also completed a survey...
November 27, 2017: Cardiovascular Drugs and Therapy
https://www.readbyqxmd.com/read/29141781/heart-failure-with-preserved-borderline-and-reduced-ejection-fraction-5-year-outcomes
#5
Kevin S Shah, Haolin Xu, Roland A Matsouaka, Deepak L Bhatt, Paul A Heidenreich, Adrian F Hernandez, Adam D Devore, Clyde W Yancy, Gregg C Fonarow
BACKGROUND: Patients with heart failure (HF) have a poor prognosis and are categorized by ejection fraction (EF). OBJECTIVES: This study sought to characterize differences in outcomes in patients hospitalized with heart failure with preserved ejection fraction (HFpEF) (EF ≥50%), heart failure with borderline ejection fraction (HFbEF) (EF 41% to 49%), and heart failure with reduced ejection fraction (HFrEF) (EF ≤40%). METHODS: Data from GWTG-HF (Get With The Guidelines-Heart Failure) were linked to Medicare data for longitudinal follow-up...
October 31, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29042791/profile-of-sacubitril-valsartan-in-the-treatment-of-heart-failure-patient-selection-and-perspectives
#6
REVIEW
Srikanth Yandrapalli, Gabriela Andries, Medha Biswas, Sahil Khera
With an estimated prevalence of 5.8 million in the USA and over 23 million people worldwide, heart failure (HF) is growing in epidemic proportions. Despite the use of guideline-directed medical therapies such as angiotensin-converting enzyme inhibitors, beta-adrenergic blockers, angiotensin receptor blockers, and mineralocorticoid receptor antagonists for chronic systolic HF for almost two decades, HF remains a leading cause of morbidity, mortality, and health care expenditures. The Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial provided compelling evidence for the cardiovascular and mortality benefit of sacubitril/valsartan when compared to enalapril in patients with heart failure and reduced ejection fraction (HFrEF)...
2017: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/29032140/heart-failure-with-mid-range-borderline-ejection-fraction-clinical-implications-and-future-directions
#7
REVIEW
Jeffrey J Hsu, Boback Ziaeian, Gregg C Fonarow
Heart failure (HF) with borderline ejection fraction was first defined in 2013 in the American College of Cardiology/American Heart Association guidelines as the presence of the typical symptoms of HF and a left ventricular ejection fraction (LVEF) of 41% to 49%. In 2016, the European Society of Cardiology specified HF with mid-range ejection fraction (HFmrEF) as LVEF of 40% to 49%. This range of LVEF is less well studied compared with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)...
November 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28982501/pulmonary-artery-pressure-guided-management-of-patients-with-heart-failure-and-reduced-ejection-fraction
#8
RANDOMIZED CONTROLLED TRIAL
Michael M Givertz, Lynne W Stevenson, Maria R Costanzo, Robert C Bourge, Jordan G Bauman, Gregg Ginn, William T Abraham
BACKGROUND: Despite increased use of guideline-directed medical therapy (GDMT), some patients with heart failure and reduced ejection fraction (HFrEF) remain at high risk for hospitalization and mortality. Remote monitoring of pulmonary artery (PA) pressures provides clinicians with actionable information to help further optimize medications and improve outcomes. OBJECTIVES: CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients trial) analyzed PA pressure-guided heart failure (HF) management in patients with HFrEF based on their ability to tolerate GDMT...
October 10, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28901848/pulmonary-hypertension-secondary-to-left-heart-disease
#9
Ghazal Kabbach, Debabrata Mukherjee
Pulmonary hypertension (PH) related to left heart disease (LHD) is the most common form of PH, accounting for more than two third of all PH cases. The hemodynamic abnormalities seen in PH-LHD are complex, and there are currently minimal evidence-based recommendations for the management of PH-LHD. While it is accepted that PH in the context of left heart disease is a marker of worse prognosis, it remains unclear whether its primary treatment is beneficial or harmful. In this article, we discuss the prevalence and significance of PH in patients with heart failure (HF) with reduced ejection fraction (HFrEF) as well as HF with preserved ejection fraction (HFpEF), and those with valvular heart disease and provide insights into the complex pathophysiology of cardiopulmonary interrelationship in individuals with PH due to left heart disease...
September 12, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28844335/sacubitril-valsartan-an-important-piece-in-the-therapeutic-puzzle-of-heart-failure
#10
REVIEW
Pedro Marques da Silva, Carlos Aguiar
Sacubitril/valsartan (LCZ696), a supramolecular sodium salt complex of the neprilysin inhibitor prodrug sacubitril and the angiotensin receptor blocker (ARB) valsartan, was recently approved in the EU and the USA for the treatment of chronic heart failure (HF) with reduced ejection fraction (HFrEF) (NYHA class II-IV). Inhibition of chronically activated neurohormonal pathways (the renin-angiotensin-aldosterone system [RAAS] and sympathetic nervous system [SNS]) is central to the treatment of chronic HFrEF. Furthermore, enhancement of the natriuretic peptide (NP) system, with favorable cardiovascular (CV) and renal effects in HF, is a desirable therapeutic goal to complement RAAS and SNS blockade...
September 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28829876/effect-of-natriuretic-peptide-guided-therapy-on-hospitalization-or-cardiovascular-mortality-in-high-risk-patients-with-heart-failure-and-reduced-ejection-fraction-a-randomized-clinical-trial
#11
RANDOMIZED CONTROLLED TRIAL
G Michael Felker, Kevin J Anstrom, Kirkwood F Adams, Justin A Ezekowitz, Mona Fiuzat, Nancy Houston-Miller, James L Januzzi, Daniel B Mark, Ileana L Piña, Gayle Passmore, David J Whellan, Hongqiu Yang, Lawton S Cooper, Eric S Leifer, Patrice Desvigne-Nickens, Christopher M O'Connor
Importance: The natriuretic peptides are biochemical markers of heart failure (HF) severity and predictors of adverse outcomes. Smaller studies have evaluated adjusting HF therapy based on natriuretic peptide levels ("guided therapy") with inconsistent results. Objective: To determine whether an amino-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided treatment strategy improves clinical outcomes vs usual care in high-risk patients with HF and reduced ejection fraction (HFrEF)...
August 22, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28795299/adherence-to-optimal-heart-rate-control-in-heart-failure-with-reduced-ejection-fraction-insight-from-a-survey-of-heart-rate-in-heart-failure-in-sweden-hr-hf-study
#12
M Fu, U Ahrenmark, S Berglund, C J Lindholm, A Lehto, A Månsson Broberg, G Tasevska-Dinevska, G Wikstrom, A Ågard, B Andersson
INTRODUCTION: Despite that heart rate (HR) control is one of the guideline-recommended treatment goals for heart failure (HF) patients, implementation has been painstakingly slow. Therefore, it would be important to identify patients who have not yet achieved their target heart rates and assess possible underlying reasons as to why the target rates are not met. MATERIALS AND METHODS: The survey of HR in patients with HF in Sweden (HR-HF survey) is an investigator-initiated, prospective, multicenter, observational longitudinal study designed to investigate the state of the art in the control of HR in HF and to explore potential underlying mechanisms for suboptimal HR control with focus on awareness of and adherence to guidelines for HR control among physicians who focus on the contributing role of beta-blockers (BBs)...
August 9, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28774374/effectiveness-and-cost-effectiveness-of-serum-b-type-natriuretic-peptide-testing-and-monitoring-in-patients-with-heart-failure-in-primary-and-secondary-care-an-evidence-synthesis-cohort-study-and-cost-effectiveness-model
#13
Maria Pufulete, Rachel Maishman, Lucy Dabner, Syed Mohiuddin, William Hollingworth, Chris A Rogers, Julian Higgins, Mark Dayer, John Macleod, Sarah Purdy, Theresa McDonagh, Angus Nightingale, Rachael Williams, Barnaby C Reeves
BACKGROUND: Heart failure (HF) affects around 500,000 people in the UK. HF medications are frequently underprescribed and B-type natriuretic peptide (BNP)-guided therapy may help to optimise treatment. OBJECTIVE: To evaluate the clinical effectiveness and cost-effectiveness of BNP-guided therapy compared with symptom-guided therapy in HF patients. DESIGN: Systematic review, cohort study and cost-effectiveness model. SETTING: A literature review and usual care in the NHS...
August 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28625374/change-the-management-of-patients-with-heart-failure-rationale-and-design-of-the-champ-hf-registry
#14
MULTICENTER STUDY
Adam D DeVore, Laine Thomas, Nancy M Albert, Javed Butler, Adrian F Hernandez, J Herbert Patterson, John A Spertus, Fredonia B Williams, Stuart J Turner, Wing W Chan, Carol I Duffy, Kevin McCague, Xiaojuan Mi, Gregg C Fonarow
Heart failure (HF) with reduced ejection fraction (HFrEF) is a common and costly condition that diminishes patients' health status and confers a poor prognosis. Despite the availability of multiple guideline-recommended pharmacologic and cardiac device therapies for patients with chronic HFrEF, outcomes remain suboptimal. Currently, there is limited insight into the rationale underlying clinical decisions by health care providers and patient factors that guide the use and intensity of outpatient HF treatments...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28602370/the-role-of-positive-inotropic-drugs-in-the-treatment-of-older-adults-with-heart-failure-and-reduced-ejection-fraction
#15
REVIEW
Daniel J Dooley, Phillip H Lam, Ali Ahmed, Wilbert S Aronow
Positive inotropic drugs have long been studied for their potential benefits in patients with heart failure and reduced ejection fraction (HFrEF). Although there has been an extensive amount of research about the clinical effects of these drugs in general, few studies examined their effect in older patients. Therefore, there is little or no evidence to guide the use of positive inotropes in older patients with HFrEF. However, recommendations from national heart failure guidelines may be generalized to older HFrEF patients on an individual basis, taking into consideration the basic geriatric principles of pharmacotherapy: start low and go slow...
July 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/28530501/palliative-care-for-advanced-heart-failure-in-a-department-of-veterans-affairs-regional-hospice-program-patient-selection-a-treatment-protocol-and-clinical-course
#16
George J Taylor, Dorothy M Lee, Catalin F Baicu, Michael R Zile
BACKGROUND: Palliative care for advanced heart failure (HF) is generally recommended. However, few reports have focused on the particulars of treatment, or the clinical course of HF on a specific treatment regimen. OBJECTIVE: Palliation adequate to allow patients to avoid HF admission and die at home. METHODS: Patients from a veterans administration regional practice with multiple, recent hospital admissions were enrolled in community hospice programs...
October 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28496549/phosphodiesterase-5-inhibitors-improve-clinical-outcomes-exercise-capacity-and-pulmonary-hemodynamics-in-patients-with-heart-failure-with-reduced-left-ventricular-ejection-fraction-a-meta-analysis
#17
Renato De Vecchis, Arturo Cesaro, Carmelina Ariano, Anna Giasi, Carmela Cioppa
BACKGROUND: Several studies have compared the use of phosphodiesterase-5 (PDE5) inhibitors sildenafil or udenafil with the placebo in patients suffering from pulmonary hypertension (PH) due to left chronic heart failure (CHF), corresponding to group 2 (PH due to left heart disease) of the PH classification (according to 2015 ESC/ERS guidelines for the diagnosis and treatment of PH). The results of the use of PDE5 inhibitors in the PH due to left heart disease were inconsistent and heterogeneous...
June 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/28492561/-sacubitril-valsartan-a-new-and-effective-treatment-for-heart-failure-with-reduced-ejection-fraction
#18
Michele Senni, Bruno Trimarco, Michele Emdin, Luciano De Biase
Despite significant therapeutic advances, patients with chronic heart failure and reduced ejection fraction (HFrEF) remain at high risk for heart failure progression and death. The PARADIGM-HF study, the largest outcome trial in HFrEF, has shown improved cardiovascular outcomes with sacubitril/valsartan (Entresto®, Novartis), previously known as LCZ696, compared with angiotensin-converting enzyme (ACE) inhibitor therapy, possibly leading us to a new era for heart failure treatment. Sacubitril/valsartan represents a first-in-class drug acting through inhibition of angiotensin receptor and neprilysin, thus modulating the renin-angiotensin-aldosterone system and vasoactive substances such as natriuretic peptides...
January 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28476146/heart-failure-in-patients-with-coronary-heart-disease-prevalence-characteristics-and-guideline-implementation-results-from-the-german-euroaspire-iv-cohort
#19
Caroline Morbach, Martin Wagner, Stefan Güntner, Carolin Malsch, Mehmet Oezkur, David Wood, Kornelia Kotseva, Rainer Leyh, Georg Ertl, Wolfgang Karmann, Peter U Heuschmann, Stefan Störk
BACKGROUND: Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation...
May 5, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28463464/physicians-guideline-adherence-is-associated-with-better-prognosis-in-outpatients-with-heart-failure-with-reduced-ejection-fraction-the-qualify-international-registry
#20
Michel Komajda, Martin R Cowie, Luigi Tavazzi, Piotr Ponikowski, Stefan D Anker, Gerasimos S Filippatos
AIMS: To evaluate the impact of physicians' adherence to guideline-recommended medications for heart failure with reduced ejection fraction (HFrEF), including ≥50% prescription of recommended doses, on clinical outcomes at 6-month follow-up. METHODS AND RESULTS: In QUALIFY, an international, prospective, observational, longitudinal survey, 6669 outpatients with HFrEF were recruited 1-15 months after heart failure (HF) hospitalization from September 2013 to December 2014 in 36 countries and followed up at 6 months...
November 2017: European Journal of Heart Failure
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