European Journal of Heart Failure, Journal Year: 2023, Volume and Issue: 25(11), P. 1887 - 1890
Published: Nov. 1, 2023
Language: Английский
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.
Language: Английский
Citations
31
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.
Language: Английский
Citations
17
European Journal of Heart Failure, Journal Year: 2025, Volume and Issue: unknown
Published: Feb. 26, 2025
Language: Английский
Citations
2
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.
Language: Английский
Citations
24
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).
Language: Английский
Citations
23
European Heart Journal - Digital Health, Journal Year: 2024, Volume and Issue: 5(6), P. 670 - 682
Published: Aug. 30, 2024
Abstract The 2021 European Society of Cardiology guideline on diagnosis and treatment acute chronic heart failure (HF) the 2023 Focused Update include recommendations pharmacotherapy for patients with New York Heart Association (NYHA) class II–IV HF reduced ejection fraction. However, multinational data from EVOLUTION study found substantial prescribing inertia guideline-directed medical therapy (GDMT) in clinical practice. cause was multifactorial included limitations organizational resources. Digital solutions like digital consultation, remote monitoring, interrogation cardiac implantable electronic devices, decision support systems, multifaceted interventions are increasingly available worldwide. objectives this Clinical Consensus Statement to provide (i) examples that can aid optimization prescription GDMT, (ii) evidence-based insights GDMT using solutions, (iii) current evidence gaps implementation barriers limit adoption practice, (iv) critically discuss strategies achieve equality access, reference patient subgroups. Embracing through use consults monitoring will future-proof, example alerts clinicians, informing them suboptimal GDMT. Researchers should consider employing optimize effectiveness designs fit unique sociotechnical aspects solutions. Artificial intelligence handle larger sets relieve professionals’ workloads, but as artificial limited, further investigation is warranted.
Language: Английский
Citations
5
Nature Medicine, Journal Year: 2024, Volume and Issue: unknown
Published: Aug. 31, 2024
Abstract Guideline-directed medical therapy (GDMT) has clear benefits on morbidity and mortality in patients with heart failure; however, GDMT use remains low. In the multicenter, open-label, investigator-initiated ADMINISTER trial, ( n = 150) diagnosed failure reduced ejection fraction (HFrEF) were randomized (1:1) to receive usual care or a strategy using digital consults (DCs). DCs contained (1) data sharing from patient clinician (pharmacotherapy use, home-measured vital signs Kansas City Cardiomyopathy Questionnaires); (2) education via text-based e-learning; (3) guideline recommendations all treating clinicians. All remotely gathered information was processed into summary that available clinicians electronic health record before every consult. interactions standardly conducted remotely. The primary endpoint change score over 12 weeks (ΔGDMT); this directly incorporated non-conditional class 1 indications for HFrEF equal weights. trial met its outcome of achieving higher DC group after follow-up (ΔGDMT group: median 1.19, interquartile range (0.25, 2.3) arbitrary units versus 0.08 (0.00, 1.00) care; P < 0.001). To our knowledge, is first multicenter controlled proves effective achieve optimization. ClinicalTrials.gov registration: NCT05413447 .
Language: Английский
Citations
3
European Journal of Preventive Cardiology, Journal Year: 2024, Volume and Issue: 31(11), P. 1372 - 1384
Published: June 3, 2024
Abstract Aims The study investigates the prognosis of atrial fibrillation (AF) in patients with heart failure mildly reduced ejection fraction (HFmrEF). Data concerning prognostic impact AF HFmrEF is scarce. Methods and results Consecutive [i.e. left ventricular 41–49% signs and/or symptoms (HF)] were retrospectively included at one institution from 2016 to 2022. Patients compared without regard primary composite endpoint all-cause mortality HF-related rehospitalization 30 months (median follow-up). Statistical analyses Kaplan–Meier, multivariable Cox proportional regression analyses, propensity score matching. A total 2148 an overall prevalence 43%. presence was associated a higher risk [hazard ratio (HR) = 2.068; 95% confidence interval (CI) 1.802–2.375; P 0.01], which confirmed after matching (HR 1.494; CI 1.216–1.835; 0.01). independent predictor both 1.340; 1.066–1.685; 0.01) 2.061; 1.538–2.696; Finally, rhythm control may be lower rate for 0.342; 0.199–0.587; Conclusion Atrial affects 43% represents adverse long-term prognosis.
Language: Английский
Citations
3
Heart Failure Reviews, Journal Year: 2024, Volume and Issue: 29(5), P. 1065 - 1077
Published: July 22, 2024
Heart failure (HF) is a systemic disease associated with high risk of morbidity, mortality, increased hospitalizations, and low quality life. Therefore, effective, treatment strategies are necessary to mitigate these risks. In this manuscript, we emphasize the concept high-intensity care optimize guideline-directed medical therapy (GDMT) in HF patients. The document highlights importance achieving optimal recommended doses GDMT medications, including beta-blockers, renin-angiotensin-aldosterone inhibitors, mineralocorticoid receptor antagonists, sodium-glucose cotransporter inhibitors improve patient outcomes, achieve sustainable decongestion, also discusses potential obstacles optimization, such as clinical inertia, physiological limitations, comorbidities, non-adherence, frailty. Lastly, it attempts provide possible future scenarios high-intensive that could outcomes.
Language: Английский
Citations
2
ESC Heart Failure, Journal Year: 2023, Volume and Issue: 11(1), P. 560 - 569
Published: Dec. 26, 2023
Many heart failure (HF) patients do not receive optimal guideline-directed medical therapy (GDMT) despite clear benefit on morbidity and mortality outcomes. Digital consults (DCs) have the potential to improve efficiency GDMT optimization serve growing HF population. The investigator-initiated ADMINISTER trial was designed as a pragmatic multicenter randomized controlled open-label evaluate efficacy safety of DC in treatment.
Language: Английский
Citations
4