The Egyptian Heart Journal,
Journal Year:
2024,
Volume and Issue:
76(1)
Published: Sept. 13, 2024
Abstract
Background
The
beta-blocker
(BB)
initiation
in
acute
heart
failure
(AHF)
patients
is
still
controversial.
Some
show
the
benefit
of
BB
employment
decreasing
mortality
outcome.
This
study
aims
to
assess
safety
and
efficacy
in-hospital
long-term
outcomes
AHF
hospitalized
patients.
We
searched
multiple
databases
examining
outcome
who
had
administered
as
therapy
initiation.
Primary
were
all-cause
mortality,
composite
endpoint
after
when
hospitalized,
post-discharge
mortality.
secondary
adverse
events
initiation,
including
hypotension
symptomatic
bradycardia
hospitalization
rehospitalization.
Results
Eight
cohort
studies
with
16,639
suffering
from
cardiogenic
shock,
9923
participants
allocated
early
group
6,713
control
group.
follow-up
durations
ranged
2
24
months.
Early
administration
significantly
reduced
endpoints
(RR:
0.42;
95%
CI
(0.30–0.58);
p
<
0.001),
0.43;
(0.31–0.61);
discharge
0.51;
(0.41–0.63);
rehospitalization
0.57;
(0.44–0.74);
0.001).
There
no
discernible
differences
BB-related
between
two
groups
(
=
0.13).
Subgroup
analyses
conducted
on
presenting
shock
revealed
significant
similar
results
shown
naive
population.
Conclusions
shows
advantages
ESC Heart Failure,
Journal Year:
2024,
Volume and Issue:
unknown
Published: May 28, 2024
Abstract
In
the
last
years,
major
progress
has
occurred
in
heart
failure
(HF)
management.
The
2023
ESC
focused
update
of
2021
HF
guidelines
introduced
new
key
recommendations
based
on
results
years
science.
First,
two
drugs,
sodium–glucose
co‐transporter‐2
(SGLT2)
inhibitors
and
finerenone,
a
novel
nonsteroidal,
selective
mineralocorticoid
receptor
antagonist
(MRA),
are
recommended
for
prevention
patients
with
diabetic
chronic
kidney
disease
(CKD).
Second,
SGLT2
now
treatment
across
entire
left
ventricular
ejection
fraction
spectrum.
benefits
quadruple
therapy
reduced
(HFrEF)
well
established.
Its
rapid
early
up‐titration
along
close
follow‐up
frequent
clinical
laboratory
re‐assessment
after
an
episode
acute
(the
so‐called
‘high‐intensity
care’
strategy)
was
associated
better
outcomes
STRONG‐HF
trial.
Patients
experiencing
worsening
might
require
fifth
drug,
vericiguat.
STEP‐HFpEF‐DM
STEP‐HFpEF
trials,
semaglutide
2.4
mg
once
weekly
administered
1
year
decreased
body
weight
significantly
improved
quality
life
6
min
walk
distance
obese
preserved
(HFpEF)
or
without
history
diabetes.
Further
data
safety
efficacy,
including
also
hard
endpoints,
needed
to
support
addition
acetazolamide
hydrochlorothiazide
standard
diuretic
regimen
hospitalized
due
HF.
meantime,
PUSH‐AHF
supported
use
natriuresis‐guided
therapy.
options
most
recent
evidence
HF,
specific
drugs
cardiomyopathies
(i.e.,
mavacamten
hypertrophic
cardiomyopathy
tafamidis
transthyretin
cardiac
amyloidosis),
device
therapies,
contractility
modulation
percutaneous
valvulopathies,
finding
from
TRILUMINATE
Pivotal
trial,
reviewed
this
article.
European Journal of Heart Failure,
Journal Year:
2024,
Volume and Issue:
26(6), P. 1278 - 1297
Published: May 22, 2024
Abstract
Guideline‐directed
medical
therapy
(GDMT)
in
patients
with
heart
failure
and
reduced
ejection
fraction
(HFrEF)
reduces
morbidity
mortality,
but
its
implementation
is
often
poor
daily
clinical
practice.
Barriers
to
include
organizational
factors
that
might
contribute
inertia,
i.e.
avoidance/delay
of
recommended
treatment
initiation/optimization.
The
spectrum
strategies
be
applied
foster
GDMT
wide,
involves
the
set‐up
care
pathways,
tailored
drug
initiation/optimization
increasing
chance
successful
implementation,
digital
tools/telehealth
interventions,
educational
activities
targeting
patient/physician
awareness,
use
quality
registries.
This
scientific
statement
by
Heart
Failure
Association
ESC
provides
an
overview
current
state
HFrEF,
barriers
aims
at
suggesting
a
comprehensive
framework
on
how
overcome
inertia
ultimately
improve
HFrEF
based
up‐to‐date
evidence.
European Journal of Heart Failure,
Journal Year:
2023,
Volume and Issue:
26(2), P. 327 - 337
Published: Nov. 7, 2023
Persistent
symptoms
despite
guideline-directed
medical
therapy
(GDMT)
and
poor
tolerance
of
GDMT
are
hallmarks
patients
with
advanced
heart
failure
(HF)
reduced
ejection
fraction
(HFrEF).
However,
real-world
data
on
use,
dose,
prognostic
implications
lacking.
European Journal of Heart Failure,
Journal Year:
2023,
Volume and Issue:
26(4), P. 854 - 868
Published: Dec. 22, 2023
The
aim
of
this
analysis
was
to
provide
data
on
the
overall
comorbidity
burden,
both
cardiovascular
(CV)
and
non-CV,
in
a
large
real-world
heart
failure
(HF)
population
across
ejection
fraction
(EF).
Heart,
Journal Year:
2025,
Volume and Issue:
unknown, P. heartjnl - 324160
Published: Jan. 29, 2025
Background
Early
heart
failure
(HF)
diagnosis
is
crucial
to
ensure
that
optimal
guideline-directed
medical
therapy
(GDMT)
administered
reduce
morbidity
and
mortality.
Limited
access
echocardiography
could
lead
a
later
for
patients,
example,
during
an
HF
hospitalisation
(hHF).
This
study
aimed
compare
the
incidence
outcomes
of
inpatient
versus
outpatient
HF.
Methods
Electronic
health
records
were
linked
data
between
2015
2021
from
patients
in
Tayside,
Scotland
(population~450
000).
Incident
was
classified
into
or
stratified
by
ejection
fraction
(EF).
A
non-HF
comparator
group
with
normal
left
ventricular
function
also
defined.
The
primary
outcome
time
cardiovascular
death
hHF
within
12
months
diagnosis.
Results
In
total,
5223
individuals
identified,
4231
(1115
reduced
(HFrEF),
666
mildly
fraction,
1402
preserved
1048
unknown
EF)
992
comparators.
Of
2169
(51.3%)
diagnosed
as
inpatients.
observed
1193
(28.1%)
32
(3.2%)
comparators
significantly
more
likely
occur
inpatients
than
outpatients
(809
vs
384
events;
adjusted
HR:
1.62
(1.39–1.89),
p<0.001),
this
consistent
regardless
EF.
For
HFrEF
first
inpatients,
those
discharged
on
≥2
GDMT
had
compared
<2
(303
175
0.72
(0.55–0.94),
p=0.016).
Conclusions
Individuals
whose
presentation
worse
who
community.
Among
hospitalised
individuals,
higher
use
associated
improved
outcomes.
Our
results
highlight
importance
improving
diagnostic
pathways
allow
earlier
identification
treatment
Journal of Cardiac Failure,
Journal Year:
2023,
Volume and Issue:
30(4), P. 525 - 537
Published: Oct. 9, 2023
BackgroundSTRONG-HF
demonstrated
the
safety
and
efficacy
of
rapid
up-titration
guideline-directed
medical
therapy
(GDMT)
with
high
intensity
care
(HIC)
compared
to
usual
in
patients
hospitalized
for
acute
heart
failure
(HF).
In
HIC
group,
following
indicators
were
used
guide
up-titration:
estimated
glomerular
filtration
rate
[eGFR]
<30ml/min/1.73m2,
serum
potassium
>5.0
mmol/L,
systolic
blood
pressure
(SBP)
<95mmHg,
<55bpm,
NT-proBNP
concentration
>10%
higher
than
pre-discharge
values.MethodsWe
examined
impact
protocol-specified
on
achieved
dose
GDMT
clinical
outcomes.ResultsThree-hundred-thirteen
542
arm
(57.7%)
met
at
least
one
indicator
any
follow-up
visit
1
6
weeks
after
discharge.
As
those
without,
meeting
had
more
severe
HF
symptoms,
lower
SBP
baseline
a
average
percentage
optimal
doses
(mean
difference
vs
not
reaching
indicator,
-11.0%
[95%
CI
-13.6
-8.4%],
P<0.001).
The
primary
endpoint
180-day
all-cause
death
or
re-admission
occurred
15.0%
versus
14.2%
without
(adjusted
hazard
ratio
[HR]
0.84,
95%
0.48
1.46,
P=0.540).
None
each
considered
alone,
was
significantly
associated
endpoint,
but
<
95mmHg
trend
towards
increased
180
days
mortality
HR
=
2.68
[0.94
7.64];
P
0.065)
eGFR
drop
30ml/min/1.73m2
readmissions
3.60
[1.22
10.60];
p
0.0203).
occurrence
smaller
90-day
improvement
EQ-5D
VAS
mean
-3.32
points,
-5.97
-0.66,
P=0.015).ConclusionsAmong
enrolled
STRONG-HF
arm,
administration
slightly
less
quality
life
no
significant
increase
outcome
readmission
when
appropriately
addressed
according
study
protocol.
