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Zahir Anjum D, Strange JE, Fosbøl E, Garred CH, Elmegaard M, Andersson C, Jhund PS, McMurray JJV, Petrie MC, Kober L, Schou M. Use of medical therapy and risk of clinical events according to frailty in heart failure patients - A real-life cohort study. Eur J Heart Fail 2024. [PMID: 38700461 DOI: 10.1002/ejhf.3249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
AIMS Although recent randomized clinical trials have demonstrated the advantages of heart failure (HF) therapy in both frail and not frail patients, there is insufficient information on the use of HF therapy based on frailty status in a real-world setting. The aim was to examine how frailty status in HF patients associates with use of HF therapy and with clinical outcomes. METHODS AND RESULTS Patients with new-onset HF between 2014 and 2021 were identified using the nationwide Danish registers. Patients across the entire range of ejection fraction were included. The associations between frailty status (using the Hospital Frailty Risk Score) and use of HF therapy and clinical outcomes (all-cause mortality, HF hospitalization, and non-HF hospitalization) were evaluated using multivariable-adjusted Cox models adjusting for age, sex, diagnostic setting, calendar year, comorbidities, pharmacotherapy, and socioeconomic status. Of 35 999 participants (mean age 69.1 years), 68% were not frail, 26% were moderately frail, and 6% were severely frail. The use of HF therapy was significantly lower in frailer patients. The hazard ratio (HR) for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker initiation was 0.74 (95% confidence interval 0.70-0.77) and 0.48 (0.43-0.53) for moderate frailty and severe frailty, respectively. For beta-blockers, the corresponding HRs were 0.74 (0.71-0.78) and 0.51 (0.46-0.56), respectively, and for mineralocorticoid receptor antagonists, 0.83 (0.80-0.87) and 0.58 (0.53-0.64), respectively. The prevalence of death and non-HF hospitalization increased with frailty status. The HR for death was 1.55 (1.47-1.63) and 2.32 (2.16-2.49) for moderate and severe frailty, respectively, and the HR for non-HF hospitalization was 1.37 (1.32-1.41) and 1.82 (1.72-1.92), respectively. The association between frailty status and HF hospitalization was not significant (HR 1.08 [1.02-1.14] and 1.08 [0.97-1.20], respectively). CONCLUSION In real-world HF patients, frailty was associated with lower HF therapy use and with a higher incidence of clinical outcomes including mortality and non-HF hospitalization.
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Affiliation(s)
- Deewa Zahir Anjum
- Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mariam Elmegaard
- Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark
| | - Charlotte Andersson
- Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Lars Kober
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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DE Albuquerque DC, DE Barros E Silva PGM, Lopes RD, Hoffmann-Filho CR, Nogueira PR, Reis H, Nishijuka FA, Martins SM, DE Figueiredo Neto JA, Pavanello R, DE Souza Neto JD, Danzmann LC, Gemelli JR, Rohde LEP, Hernandes ME, Rivera MAM, Simões MVIN, Dos Santos ES, Canesin MF, Zilli AC, Santos RHN, Jesuino IDEA, Mourilhe-Rocha R, Moura LZ, Marcondes-Braga FG, Mesquita ET. In-Hospital Management and Long-term Clinical Outcomes and Adherence in Patients With Acute Decompensated Heart Failure: Primary Results of the First Brazilian Registry of Heart Failure (BREATHE). J Card Fail 2024; 30:639-650. [PMID: 37648061 DOI: 10.1016/j.cardfail.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Heart failure (HF), a common cause of hospitalization, is associated with poor short-term clinical outcomes. Little is known about the long-term prognoses of patients with HF in Latin America. METHODS BREATHE was the first nationwide prospective observational study in Brazil that included patients hospitalized due to acute heart failure (HF). Patients were included during 2 time periods: February 2011-December 2012 and June 2016-July 2018 In-hospital management, 12-month clinical outcomes and adherence to evidence-based therapies were evaluated. RESULTS A total of 3013 patients were enrolled at 71 centers in Brazil. At hospital admission, 83.8% had clear signs of pulmonary congestion. The main cause of decompensation was poor adherence to HF medications (27.8%). Among patients with reduced ejection fraction, concomitant use of beta-blockers, renin-angiotensin-aldosterone inhibitors and spironolactone decreased from 44.5% at hospital discharge to 35.2% at 3 months. The cumulative incidence of mortality at 12 months was 27.7%, with 24.3% readmission at 90 days and 44.4% at 12 months. CONCLUSIONS In this large national prospective registry of patients hospitalized with acute HF, rates of mortality and readmission were higher than those reported globally. Poor adherence to evidence-based therapies was common at hospital discharge and at 12 months of follow-up.
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Affiliation(s)
| | - Pedro Gabriel Melo DE Barros E Silva
- Hcor-Hospital do Coração, São Paulo, Brazil; Hospital Samaritano Paulista, São Paulo, Brazil; Brazilian Clinical Research Institute, São Paulo, Brazil
| | - Renato D Lopes
- Brazilian Clinical Research Institute, São Paulo, Brazil; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Centro de Pesquisa da Clínica Médica e Cardiologia da UNIFESP, São Paulo, Brazil.
| | | | | | - Helder Reis
- Hospital de Clínicas Gaspar Viana, Paró, Brazil
| | | | | | | | | | | | - Luiz Claudio Danzmann
- Hospital São Lucas-PUCRS, Rio Grande do Sul, Brazil; Universidade Luterana do Brasil-Hospital Universitório de Canoas (RS), Rio Grande do Sul, Brazil
| | | | - Luis Eduardo Paim Rohde
- Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento-HMV, Rio Grande do Sul, Brazil
| | | | | | - Marcus VINíCIUS Simões
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Ricardo Mourilhe-Rocha
- Hospital Universitório Pedro Ernesto, Rio de Janeiro, Brazil; Complexo Hospitalar Américas- Vitória e Samaritano Barra, Rio de Janeiro, Brazil
| | | | - Fabiana G Marcondes-Braga
- Departamento de Insuficiência Cardíaca-DEIC-SBC, Rio de Janeiro, Brazil; Instituto do Coração (inCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Evandro Tinoco Mesquita
- Departamento de Insuficiência Cardíaca-DEIC-SBC, Rio de Janeiro, Brazil; Universidade Federal Fluminense, Rio de Janeiro, Brazil
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Cuthbert JJ, Brown OI, Pellicori P, Dobbs K, Bulemfu J, Kazmi S, Sokoreli I, Pauws SC, Riistama JM, Cleland JGF, Clark AL. Medicines optimization prior to discharge in patients admitted to hospital with heart failure. ESC Heart Fail 2024; 11:950-961. [PMID: 38229241 DOI: 10.1002/ehf2.14638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/25/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
AIMS Approximately half of patients with heart failure and a reduced ejection fraction (HeFREF) are discharged from hospital on triple therapy [angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs), beta-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs)]. We investigated what proportion of patients are on optimal doses prior to discharge and how many might be eligible for initiation of sacubitril-valsartan or sodium-glucose co-transporter-2 inhibitors (SGLT2Is). METHODS AND RESULTS Between 2012 and 2017, 1277 patients admitted with suspected heart failure were enrolled at a single hospital serving a local community around Kingston upon Hull, UK. Eligibility for sacubitril-valsartan or SGLT2I was based on entry criteria for the PIONEER-HF, DAPA-HF, and EMPEROR-Reduced trials. Four hundred fifty-five patients had HeFREF with complete data on renal function, heart rate, and systolic blood pressure (SBP) prior to discharge. Eighty-three per cent of patients were taking an ACE-I or ARB, 85% a BB, and 63% an MRA at discharge. More than 60% of patients were eligible for sacubitril-valsartan and >70% for SGLT2I. Among those not already receiving a prescription, 37%, 28%, and 49% were eligible to start ACE-I or ARB, BB, and MRA, respectively. Low SBP (≤105 mmHg) was the most frequent explanation for failure to initiate or up-titrate therapy. CONCLUSIONS Most patients admitted for heart failure are eligible for initiation of life-prolonging medications prior to discharge. A hospital admission may be a common missed opportunity to improve treatment for patients with HeFREF.
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Affiliation(s)
- Joseph J Cuthbert
- Clinical Sciences Centre, Hull York Medical School, University of Hull, Kingston upon Hull, East Riding of Yorkshire, UK
- Department of Cardiology, Hull University Teaching Hospital Trust, Castle Hill Hospital, Kingston upon Hull, East Riding of Yorkshire, UK
| | - Oliver I Brown
- Clinical Sciences Centre, Hull York Medical School, University of Hull, Kingston upon Hull, East Riding of Yorkshire, UK
- Department of Cardiology, Hull University Teaching Hospital Trust, Castle Hill Hospital, Kingston upon Hull, East Riding of Yorkshire, UK
| | - Pierpaolo Pellicori
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, 126 University Place, Glasgow, Glasgow, G12 8TA, Lanarkshire, UK
| | - Karen Dobbs
- Clinical Sciences Centre, Hull York Medical School, University of Hull, Kingston upon Hull, East Riding of Yorkshire, UK
| | - Jeanne Bulemfu
- Clinical Sciences Centre, Hull York Medical School, University of Hull, Kingston upon Hull, East Riding of Yorkshire, UK
| | - Syed Kazmi
- Clinical Sciences Centre, Hull York Medical School, University of Hull, Kingston upon Hull, East Riding of Yorkshire, UK
| | - Ioanna Sokoreli
- Remote Patient Management and Chronic Care, Philips Research Eindhoven, Eindhoven, The Netherlands
| | - Steffan C Pauws
- Remote Patient Management and Chronic Care, Philips Research Eindhoven, Eindhoven, The Netherlands
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
| | | | - John G F Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, 126 University Place, Glasgow, Glasgow, G12 8TA, Lanarkshire, UK
| | - Andrew L Clark
- Department of Cardiology, Hull University Teaching Hospital Trust, Castle Hill Hospital, Kingston upon Hull, East Riding of Yorkshire, UK
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Markousis-Mavrogenis G, Baumhove L, Al-Mubarak AA, Aboumsallem JP, Bomer N, Voors AA, van der Meer P. Immunomodulation and immunopharmacology in heart failure. Nat Rev Cardiol 2024; 21:119-149. [PMID: 37709934 DOI: 10.1038/s41569-023-00919-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/16/2023]
Abstract
The immune system is intimately involved in the pathophysiology of heart failure. However, it is currently underused as a therapeutic target in the clinical setting. Moreover, the development of novel immunomodulatory therapies and their investigation for the treatment of patients with heart failure are hampered by the fact that currently used, evidence-based treatments for heart failure exert multiple immunomodulatory effects. In this Review, we discuss current knowledge on how evidence-based treatments for heart failure affect the immune system in addition to their primary mechanism of action, both to inform practising physicians about these pleiotropic actions and to create a framework for the development and application of future immunomodulatory therapies. We also delineate which subpopulations of patients with heart failure might benefit from immunomodulatory treatments. Furthermore, we summarize completed and ongoing clinical trials that assess immunomodulatory treatments in heart failure and present several therapeutic targets that could be investigated in the future. Lastly, we provide future directions to leverage the immunomodulatory potential of existing treatments and to foster the investigation of novel immunomodulatory therapeutics.
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Affiliation(s)
- George Markousis-Mavrogenis
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lukas Baumhove
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ali A Al-Mubarak
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Joseph Pierre Aboumsallem
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Nils Bomer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
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Iacoviello M, Di Gesaro G, Sarullo FM, Miani D, Driussi M, Correale M, Bilato C, Passantino A, Carluccio E, Villani A, degli Esposti L, d'Agostino C, Peruzzi E, Poli S, di Lenarda A. Pharmacoutilization and adherence to sacubitril/valsartan in real world: the REAL.IT study in HFrEF. ESC Heart Fail 2024; 11:456-465. [PMID: 38041517 PMCID: PMC10804148 DOI: 10.1002/ehf2.14600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/17/2023] [Accepted: 10/31/2023] [Indexed: 12/03/2023] Open
Abstract
AIMS The current European Society of Cardiology (ESC) guidelines provide clear indications for the treatment of acute and chronic heart failure (HF). Nevertheless, there is a constant need for real-world evidence regarding the effectiveness, adherence, and persistence of drug therapy. We investigated the use of sacubitril/valsartan for the treatment of HF with reduced ejection fraction in real-world clinical practice in Italy. METHODS AND RESULTS An observational, retrospective, non-interventional cohort study based on electronic medical records from nine specialized hospital HF centres in Italy was carried out on patients with prescription of sacubitril/valsartan. Overall, 948 patients had a prescription of sacubitril/valsartan, with 924 characterized over 6 months and followed up for 12 months. Pharmacoutilization data at 1 year of follow-up were available for 225 patients {mean age 69.7 years [standard deviation (SD) = 10.8], 81.8% male}. Of those, 398 (45.2%) reached the target dose of sacubitril/valsartan of 97/103 mg in a mean time of 6.9 (SD = 6.2) weeks. Blood pressure and hypotension in 61 patients (65%) and worsening of chronic kidney disease in 10 patients (10.6%) were the main reasons for not reaching the target dose. Approximatively 50% of patients had a change in sacubitril/valsartan dose during follow-up, and 158 (70.2%) were persistent with the treatment during the last 3 months of follow-up. A sensitivity analysis (persistence during the last 4 months of follow-up) showed persistence for 162 patients (72.0%). Adherence data, available for 387 patients, showed full adherence for 205 (53%). Discontinuation (102/717 patients, 14.2%) was mainly due to hypotension and occurred after a mean time of 34.3 (SD = 28.7) weeks. During follow-up, out of 606 patients with available data, 434 patients (71.6%) had an HF add-on drug or drugs concomitant with sacubitril/valsartan. HF-related hospitalization during follow-up was numerically higher in non-persistent (16/67 patients, 23.9%) vs. patients persistent to sacubitril/valsartan (30/158, 19%) (P = 0.405). CONCLUSIONS Real-world data on the use of sacubitril/valsartan in clinical practice in Italy show a rapid titration to the target dose, high therapeutic adherence enabling a good level of therapeutic management in line with ESC guidelines for patients with reduced ejection fraction.
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Affiliation(s)
| | | | - Filippo Maria Sarullo
- U.O.S. Di Riabilitazione Cardiovascolare Ospedale Buccheri La Ferla FatebenefratelliPalermoItaly
| | - Daniela Miani
- SOC Cardiologia, Dipartimento CardiotoracicoAzienda Sanitaria Universitaria Friuli Centrale, Ospedale S. Maria della MisericordiaUdineItaly
| | - Mauro Driussi
- SOC Cardiologia, Dipartimento CardiotoracicoAzienda Sanitaria Universitaria Friuli Centrale, Ospedale S. Maria della MisericordiaUdineItaly
| | - Michele Correale
- SC Universitaria di Cardiologia AOU ‘Ospedali Riuniti’ FoggiaFoggiaItaly
| | - Claudio Bilato
- U.O.C. Cardiologia Azienda ULSS 8 Berica ‐ Ospedali dell'Ovest VicentinoArzignanoItaly
| | - Andrea Passantino
- Division of Cardiology and Cardiac RehabilitationU.O. Cardiologia ICS Maugeri SpA SB Bari, IRCCS Istituto di BariBariItaly
| | - Erberto Carluccio
- Cardiologia e Fisiopatologia CardiovascolareAzienda Ospedaliera Universitaria ‘Santa Maria della Misericordia’PerugiaItaly
| | - Alessandra Villani
- UO Cardiologia, Istituto AuxologicoItaliano IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche, MetabolicheMilanItaly
| | | | | | | | | | - Andrea di Lenarda
- Cardiovascular CenterUniversity Hospital and Health Services of TriesteTriesteItaly
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Larsson JE, Denholt CS, Thune JJ, Raja AA, Fosbøl E, Schou M, Køber L, Nielsen OW, Gustafsson F, Kristensen SL. Initiation of eplerenone or spironolactone, treatment adherence, and associated outcomes in patients with new-onset heart failure with reduced ejection fraction: a nationwide cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2023; 9:546-552. [PMID: 37355774 DOI: 10.1093/ehjcvp/pvad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/19/2023] [Accepted: 06/22/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The mineralocorticoid receptor antagonists (MRAs) eplerenone and spironolactone are beneficial in heart failure with reduced ejection fraction (HFrEF), but have not been prospectively compared. We compared clinical outcomes, daily dosages, and discontinuation rates for the two drugs in a nationwide cohort. METHODS We identified all patients with HFrEF in the period 2016-2020, who were alive and had initiated MRA treatment at study start, 180 days after HF diagnosis. We estimated the 2-year risk of a composite of death and HF hospitalization, as well as each component separately, using Kaplan-Meier, cumulative incidence functions, and Cox proportional hazards models adjusted for age, sex, and comorbidities. Secondly, we assessed treatment withdrawal, cross-over, and daily drug dosage. RESULTS We included 7479 patients; 653 (9%) on eplerenone and 6840 (91%) on spironolactone. Patients in the eplerenone group were younger (median age 65 vs. 69 years), and more often men (91% vs. 68%), both P < 0.001. In adjusted analyses, with spironolactone as reference, there were no differences in the risk of the composite of all-cause death and HF hospitalization (HR 1.02, 95% CI 0.82-1.27), all-cause death (HR 0.93, 95% CI 0.67-1.30), or HF hospitalization (HR 1.10, 95% CI 0.84-1.42). Treatment withdrawal occurred in 34% in the eplerenone group and 53% in the spironolactone group (P < 0.001), treatment cross-over in 3%, and 10%, respectively. Daily dose >25 mg at 12 months, was observed in 230 patients (37%) in the eplerenone group and 771 patients (12%) in the spironolactone (P < 0.001). CONCLUSIONS In a contemporary nationwide cohort of patients with new-onset HFrEF who initiated MRA, we found no differences in clinical outcomes associated with initiation of eplerenone vs. spironolactone. Treatment was more frequently withdrawn, and daily drug dosage was lower among patients treated with spironolactone.
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Affiliation(s)
- Johan E Larsson
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Cæcilie Stilling Denholt
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 11, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Søren L Kristensen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Bhuiya T, Makaryus AN. The Importance of Engaging in Scientific Research during Medical Training. Int J Angiol 2023; 32:153-157. [PMID: 37576537 PMCID: PMC10421692 DOI: 10.1055/s-0042-1759542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Many components of required skills and competencies exist, and are felt to contribute to the successful completion of training for independent practice in the medical field as a physician. These requirements are documented and detailed in a temporal fashion during the training period and used for advancement during training as well as documentation of successful completion of that training. While clinical skill development that allows optimal care and treatment of patients is of utmost importance during this training, other components of the training are important and contribute to the ideal development of a well-rounded and credentialed physician. One of these other components which is very important and needs to be recognized is the engagement of medical trainees across disciplines in academic and research scholarly activity. This engagement is an important component of medical training, and the development of skills and didactics geared toward efficient and accurate performance of research is essential.
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Affiliation(s)
- Tanzim Bhuiya
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Amgad N. Makaryus
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Cardiology, Nassau University Medical Center, East Meadow, New York
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8
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Almeman AA, Al Mesned A, Alredaini IA, Alhumaidan RI, Alharbi SB, Alassaf FA, Alharbi SF, Alharbi SB, Alharbi HM. Assessment of Adherence to Cardiovascular Medicines in Saudi Population: An Observational Study in Patients Attending a Tertiary Care Hospital. Cardiovasc Hematol Disord Drug Targets 2023; 23:122-129. [PMID: 38093591 DOI: 10.2174/011871529x257067230927101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/19/2023] [Accepted: 08/31/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Drug adherence has been extensively evaluated in many developed countries in the West using different methods of medication adherence measurement; however, there are relatively few reports studying the adherence levels among Saudi patients. Thus, this study will evaluate the adherence to cardiovascular medicines in Saudi patients visiting (PSCC) in Al-Qassim, Saudi Arabia. METHODS This cross-sectional observational study relied on self-administered questionnaires. This study used the Morisky, Green, and Levine (MGL) Adherence Scale, also known as the MAQ (Medication Adherence Questionnaire), in PSCC's pharmacy waiting room in Qassim, Saudi Arabia. RESULTS This study included 993 PSCC pharmacy waiting room patients. The patients were between 11 and 50 years old, and 52.7 percent were male. Most participants (71.2%) were above 50, while 16.3% were 41-50. Non-adherent patients cited traveling or being busy (28.6%), forgetting (18.7%), daily multi-medications (7.1%), being sleepy or sleeping (6.6%), and not repeating the prescription (6.6%). The Medicine Adherence Questionnaire indicated that 62.6 percent of patients fully adhered to their medications, and 21.6 percent usually adhered. Only drug adverse effects affected adherence (p =0.0001). CONCLUSION The current study showed that there is a good level of adherence among patients with cardiovascular diseases toward their diseases. The most common reasons for neglecting medications include traveling or being busy, forgetting multiple medications, and being tired or sleeping. Having experience with side effects was the only significant factor affecting adherence to medications.
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Affiliation(s)
- Ahmad Abdulrahman Almeman
- Clinical Pharmacology and Therapeutic Department, College of Medicine, Qassim University (QU), Buraydah, Saudi Arabia
| | - Abdulrahman Al Mesned
- Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Buraydah, Qassim, Saudi Arabia
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9
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Ødegaard KM, Lirhus SS, Melberg HO, Hallén J, Halvorsen S. Adherence and persistence to pharmacotherapy in patients with heart failure: a nationwide cohort study, 2014-2020. ESC Heart Fail 2022; 10:405-415. [PMID: 36266969 PMCID: PMC9871690 DOI: 10.1002/ehf2.14206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS We aimed to study initiation, adherence, and long-term persistence to beta-blockers (BB), renin-angiotensin system inhibitors (RASi), and mineralocorticoid receptor antagonists (MRA) in a nationwide cohort of patients with heart failure (HF). METHODS Patients aged 18-80 years in Norway with a first diagnosis of HF from 2014 until 2020 that survived ≥30 days were identified from the Norwegian Patient Registry and linked to the Norwegian Prescription Database. We collected information about BB, RASi [angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and angiotensin receptor-neprilysin inhibitors (ARNI)], and MRA. Dual HF therapy was defined as taking at least two out of three drug classes, whereas triple HF therapy was defined as taking all three. Initiation (time to initiation) and persistence (time to discontinuation using a grace period of 30 days) of HF drugs was calculated by the Kaplan-Meier method, followed to outcome of interest, death, or December 2020. One-year adherence was measured as proportion of days covered (PDC) using a cut-off at 80%. For adherence and persistence measurements, we allowed for maximum 60 days of stockpiling and switching within drug groups. We performed sensitivity analyses to test the robustness of our findings. RESULTS Out of 54 899 patients included in the cohort, 75%, 69%, and 21% initiated a BB, RASi, and MRA, respectively, whereas 13% did not receive any. Dual and triple HF therapy was prescribed to 61% and 16%, respectively. The proportion of adherent patients during the first year following initiation was 83%, 81%, 84%, and 61% for BB, RASi, ARNI, and MRA, whereas 42% and 5% were adherent to dual and triple HF therapy, respectively. From 2 to 5 years following initiation, persistence decreased from 58% to 38%, 57% to 37%, and 31% to 15% for BB, RASi, and MRA, respectively. Within the RASi group, persistence was higher for ARNI than for ACEI and ARB. There were no major changes in either initiation or adherence of the drug classes from 2014 to 2019, except for an increase in initiation and adherence of MRA. CONCLUSIONS We found low adherence to dual and triple HF therapies in this nationwide cohort study of newly diagnosed HF patients. Efforts are needed to increase adherence and persistence to HF therapies into clinical practice, emphasizing maintenance of multiple drug therapies in patients with such an indication.
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Affiliation(s)
| | | | - Hans Olav Melberg
- Department of Community MedicineUiT ‐ The Arctic University of NorwayTromsøNorway
| | | | - Sigrun Halvorsen
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Department of CardiologyOslo University Hospital UllevalOsloNorway
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10
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Restivo A, D'Amario D, Paglianiti DA, Laborante R, Princi G, Cappannoli L, Iaconelli A, Galli M, Aspromonte N, Locorotondo G, Burzotta F, Trani C, Crea F. A 3-Year Single Center Experience With Left Atrial Pressure Remote Monitoring: The Long and Winding Road. Front Cardiovasc Med 2022; 9:899656. [PMID: 35770220 PMCID: PMC9236153 DOI: 10.3389/fcvm.2022.899656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite continuous advancement in the field, heart failure (HF) remains the leading cause of hospitalization among the elderly and the overall first cause of hospital readmission in developed countries. Implantable hemodynamic monitoring is being tested to anticipate the clinical exacerbation onset, potentially preventing an emergent acute decompensation. To date, only pulmonary artery pressure (PAP) sensor received the approval to be implanted in symptomatic heart failure patients with reduced ejection fraction. However, PAP's indirect estimation of left ventricular filling pressure can be inaccurate in some contexts.MethodsThe VECTOR-HF study (NCT03775161) is examining the safety, usability and performance of the V-LAP system, a latest-generation device capable of continuously monitoring left atrial pressure (LAP). In our center, five advanced HF patients have been enrolled. After confirmation of the transmitted data reliability, LAP trends and waveforms have guided therapy optimization. The aim of this work is to share clinical insights from our center preliminary experience with V-LAP application.ResultsOver a median follow-up time of 18 months, LAP–based therapy optimization managed to reduce intracardiac pressure over time and no hospital readmission occurred. This result was paralleled by an improvement in both functional capacity (6MWT distance 352.5 ± 86.2 meters at baseline to 441.2 ± 125.2 meters at last follow-up) and quality of life indicators (KCCQ overall score 63.82 ± 16.36 vs. 81.92 ± 9.63; clinical score 68.47 ± 19.48 vs. 83.70 ± 15.58).ConclusionPreliminary evidence from V-LAP application at our institution support a promising efficacy. However, further study is needed to confirm the technical reliability of the device and to exploit the clinical benefit of left-sided hemodynamic remote monitoring.
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Affiliation(s)
- Attilio Restivo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- *Correspondence: Domenico D'Amario
| | - Donato Antonio Paglianiti
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Cappannoli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Iaconelli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Locorotondo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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11
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 612] [Impact Index Per Article: 306.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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12
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 694] [Impact Index Per Article: 347.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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13
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Zahir D, Bonde A, Madelaire C, Malmborg M, Butt JH, Fosbol E, Gislason G, Torp-Pedersen C, Andersson C, Rossignol P, McMurray JJV, Kober L, Schou M. Temporal trends in initiation of mineralocorticoid receptor antagonists and risk of subsequent withdrawal in patients with heart failure: A nationwide study in Denmark from 2003-2017. Eur J Heart Fail 2021; 24:539-547. [PMID: 34969178 DOI: 10.1002/ejhf.2418] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/16/2021] [Accepted: 12/26/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS Despite landmark heart failure (HF) with reduced ejection fraction (HFrEF) trials showing effect of Mineralocorticoid Receptor Antagonists (MRA) on the risk of death and HF hospitalization, it has been suggested that MRAs are underutilized or frequently withdrawn. This study sought to identify temporal trends in the initiation of MRAs and the subsequent risk of withdrawal and adherence of MRAs in HF patients treated with a renin-angiotensin system inhibitor and a beta-blocker in Denmark from 2003-2017. METHODS AND RESULTS From nationwide registries, we identified patients receiving a diagnosis of HF. Use of MRA was identified by at least one prescription within six months after the diagnosis. The absolute risk of withdrawal with treatment was assessed with cumulative incidence, accounting for the competing risk of death. To estimate adherence, we calculated the proportion of days covered (PDC). We included 51 512 patients with incident HF. During the study period 20 779 (40.3%) patients initiated MRA therapy. The incidence of withdrawal of MRA was 49.2% throughout the study period. 48.0% of the HF patients were adherent with the treatment. Among patients withdrawing treatment with MRA, the cumulative incidence of reinitiating was 36.6%. CONCLUSIONS In a nationwide cohort of patients with HF, approximately half of the patients received MRA as third-line therapy within the first six months after diagnosis and approximately half of these withdrew MRA within 5 years. These findings warrant an increasing focus on retention to MRA treatment in a real-life setting. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Deewa Zahir
- Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark
| | - Anders Bonde
- Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark
| | | | | | - Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Emil Fosbol
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The National Institute of Public Health, University of Southern Denmark, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Research and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Andersson
- Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark.,Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Patrick Rossignol
- INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, UMR 1116, CHRU de Nancy, French-Clinical Research Infrastructure Network (F-CRIN) INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, Université de Lorraine, France
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Lars Kober
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark
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14
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Vaduganathan M, Fonarow GC, Greene SJ, Devore AD, Albert NM, Duffy CI, Hill CL, Patterson JH, Spertus JA, Thomas LE, Williams FB, Hernandez AF, Butler J. Treatment Persistence of Renin-Angiotensin-Aldosterone-System Inhibitors Over Time in Heart Failure with Reduced Ejection Fraction. J Card Fail 2021; 28:191-201. [PMID: 34428591 DOI: 10.1016/j.cardfail.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Clinical practice guidelines support sustained use of renin-angiotensin-aldosterone-system (RAAS) inhibitors over time in heart failure with reduced ejection fraction, yet few data are available regarding the frequency, timing or predictors of early treatment discontinuation in clinical practice. METHODS Among prevalent or new users of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), and mineralocorticoid receptor antagonists (MRAs) in the CHAMP-HF (Change the Management of Patients with Heart Failure) registry, we estimated the frequency and independent predictors of treatment discontinuation during follow-up. Among sites with > 5 users of a given RAAS inhibitor, we evaluated practice variation in the proportion of patients with treatment discontinuation. RESULTS Over median follow-up of 18 months, frequency of drug discontinuation of ACEis/ARBs, ARNIs and MRAs was 12.7% (444 of 3509 users), 10.4% (140 of 1352 users), and 20.4% (435 of 2129 users), respectively. An additional, 149 (11.0%) of ARNI users were switched to ACEis/ARBs, and 447 (12.7%) of ACEi/ARB users were switched to ARNIs during follow-up. Across sites, the median proportion of discontinuation of ACEis/ARBs, ARNIs and MRAs was 12.5% (25th-75th percentiles 6.9%-18.9%), 18.8% (25th-75th percentiles 12.5%-28.6%), and 19.6% (25th-75th percentiles 10.7%-27.0%), respectively. Chronic kidney disease was the only independent predictor of increased risk of discontinuation of each of the RAAS inhibitor classes (P < 0.02 for all). Higher Kansas City Cardiomyopathy Questionnaire overall summary scores independently predicted lower risk of discontinuation of ACEis/ARBs and ARNIs (both P < 0.001) but not of MRAs. Investigator clinical experience was predictive of lower risks of discontinuation of ACEis/ARBs and MRAs (P < 0.02) but not of ARNIs. All other independent predictors of discontinuation were unique to individual therapeutic classes. CONCLUSIONS One in 10 patients discontinue ACEis/ARBs or ARNIs, and 1 in 5 discontinue MRAs in routine clinical practice of heart failure with reduced ejection fraction. Unique patient-level and clinician/practice-level factors are associated with premature discontinuation of individual RAAS inhibitors, which may help to guide structured efforts to promote treatment persistence in clinical care.
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Affiliation(s)
- Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA.
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, CA
| | - Stephen J Greene
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Adam D Devore
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH
| | - Carol I Duffy
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - C Larry Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - John A Spertus
- Saint Luke's Mid-America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO
| | - Laine E Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
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15
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Watson K, Hale GM, Gale SE. Pharmacists getting to the heart of the matter in heart failure. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kristin Watson
- University of Maryland School of Pharmacy Baltimore Maryland USA
| | - Genevieve M. Hale
- Nova Southeastern University College of Pharmacy Palm Beach Gardens Florida USA
| | - Stormi E. Gale
- University of Maryland School of Pharmacy Baltimore Maryland USA
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16
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Gupta P, Voors AA, Patel P, Lane D, Anker SD, Cleland JGF, Dickstein K, Filippatos G, Lang CC, van Veldhuisen DJ, Metra M, Zannad F, Samani NJ, Jones DJL, Squire IB, Ng LL. Non-adherence to heart failure medications predicts clinical outcomes: assessment in a single spot urine sample by liquid chromatography-tandem mass spectrometry (results of a prospective multicentre study). Eur J Heart Fail 2021; 23:1182-1190. [PMID: 33759308 DOI: 10.1002/ejhf.2160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/13/2021] [Accepted: 03/19/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Liquid chromatography-mass spectrometry (LC-MS/MS) is an objective new technique to assess non-adherence to medications. We used this method to study the prevalence, predictors and outcomes of non-adherence in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). METHODS AND RESULTS This study included 1296 patients with HFrEF from BIOSTAT-CHF, a study that aimed to optimise guideline-recommended therapies. Angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, β-blockers and loop diuretics were measured in a single spot urine sample at 9 months using LC-MS/MS. The relationship between medication non-adherence and the composite endpoint of all-cause death or heart failure hospitalisation, over a median follow-up of 21 months, was evaluated. Non-adherence to at least one prescribed medication was observed in 45.9% of patients. The strongest predictor of non-adherence was non-adherence to any of the other medication classes (P < 0.0005). Regional differences within Europe were observed. On multivariable analyses, non-adherence to ACEi/ARBs and β-blockers was associated with an increased risk of the composite endpoint [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.09-1.95, P = 0.008 and HR 1.48, 95% CI 1.12-1.96, P = 0.006, respectively). Non-adherence to β-blockers was also associated with an increased risk of death (HR 2.48, 95% CI 1.67-3.68, P < 0.0005). Patients who were non-adherent to loop diuretics were healthier and had a decreased risk of the composite endpoint (HR 0.69, 95% CI 0.51-0.93, P = 0.014). Non-adherence to mineralocorticoid receptor antagonists was not related to any clinical outcome. CONCLUSION Non-adherence to medications, assessed by a single urine test, is common and predicts clinical outcomes in patients with HFrEF.
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Affiliation(s)
- Pankaj Gupta
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Prashanth Patel
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Dan Lane
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John G F Cleland
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.,National Heart & Lung Institute, Imperial College, London, UK
| | - Kenneth Dickstein
- Medicine, University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - Gerasimos Filippatos
- Cardiology, University of Cyprus, Heart Failure Unit, National and Kapodistrian University of Athens, School of Medicine, Attikon, University Hospital, Athens, Greece
| | - Chim C Lang
- Division of Molecular & Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Faiez Zannad
- Division of Heart Failure, Hypertension and Preventive Cardiology, Department of Cardiovascular Disease, Academic Hospital (CHU), Clinical Investigation Centre (Inserm-CHU), Nancy, France
| | - Nilesh J Samani
- British Heart Foundation, Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Cardiovascular Unit and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Don J L Jones
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Iain B Squire
- University of Leicester, University Hospitals of Leicester, Leicester, UK
| | - Leong L Ng
- Department of Cardiovascular Science, University of Leicester, NIHR Leicester Biomedical Research Centre, Cardiovascular Unit and University Hospitals of Leicester NHS Trust, Leicester, UK
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17
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Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, Anker SD, Atherton J, Böhm M, Butler J, Drazner MH, Michael Felker G, Filippatos G, Fiuzat M, Fonarow GC, Gomez-Mesa JE, Heidenreich P, Imamura T, Jankowska EA, Januzzi J, Khazanie P, Kinugawa K, Lam CSP, Matsue Y, Metra M, Ohtani T, Francesco Piepoli M, Ponikowski P, Rosano GMC, Sakata Y, Seferović P, Starling RC, Teerlink JR, Vardeny O, Yamamoto K, Yancy C, Zhang J, Zieroth S. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail 2021; 23:352-380. [PMID: 33605000 DOI: 10.1002/ejhf.2115] [Citation(s) in RCA: 529] [Impact Index Per Article: 176.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
In this document, we propose a universal definition of heart failure (HF) as a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. We also propose revised stages of HF as: At risk for HF (Stage A), Pre-HF (Stage B), Symptomatic HF (Stage C) and Advanced HF (Stage D). Finally, we propose a new and revised classification of HF according to left ventricular ejection fraction (LVEF). This includes HF with reduced ejection fraction (HFrEF): symptomatic HF with LVEF ≤40%; HF with mildly reduced ejection fraction (HFmrEF): symptomatic HF with LVEF 41-49%; HF with preserved ejection fraction (HFpEF): symptomatic HF with LVEF ≥50%; and HF with improved ejection fraction (HFimpEF): symptomatic HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF > 40%.
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18
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Bozkurt B, Coats AJ, Tsutsui H, Abdelhamid M, Adamopoulos S, Albert N, Anker SD, Atherton J, Böhm M, Butler J, Drazner MH, Felker GM, Filippatos G, Fonarow GC, Fiuzat M, Gomez-Mesa JE, Heidenreich P, Imamura T, Januzzi J, Jankowska EA, Khazanie P, Kinugawa K, Lam CSP, Matsue Y, Metra M, Ohtani T, Francesco Piepoli M, Ponikowski P, Rosano GMC, Sakata Y, SeferoviĆ P, Starling RC, Teerlink JR, Vardeny O, Yamamoto K, Yancy C, Zhang J, Zieroth S. Universal Definition and Classification of Heart Failure: A Report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. J Card Fail 2021; 27:S1071-9164(21)00050-6. [PMID: 33663906 DOI: 10.1016/j.cardfail.2021.01.022] [Citation(s) in RCA: 307] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
In this document, we propose a universal definition of heart failure (HF) as the following: HF is a clinical syndrome with symptoms and or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and or objective evidence of pulmonary or systemic congestion. We propose revised stages of HF as follows. At-risk for HF (Stage A), for patients at risk for HF but without current or prior symptoms or signs of HF and without structural or biomarkers evidence of heart disease. Pre-HF (stage B), for patients without current or prior symptoms or signs of HF, but evidence of structural heart disease or abnormal cardiac function, or elevated natriuretic peptide levels. HF (Stage C), for patients with current or prior symptoms and/or signs of HF caused by a structural and/or functional cardiac abnormality. Advanced HF (Stage D), for patients with severe symptoms and/or signs of HF at rest, recurrent hospitalizations despite guideline-directed management and therapy (GDMT), refractory or intolerant to GDMT, requiring advanced therapies such as consideration for transplant, mechanical circulatory support, or palliative care. Finally, we propose a new and revised classification of HF according to left ventricular ejection fraction (LVEF). The classification includes HF with reduced EF (HFrEF): HF with an LVEF of ≤40%; HF with mildly reduced EF (HFmrEF): HF with an LVEF of 41% to 49%; HF with preserved EF (HFpEF): HF with an LVEF of ≥50%; and HF with improved EF (HFimpEF): HF with a baseline LVEF of ≤40%, a ≥10-point increase from baseline LVEF, and a second measurement of LVEF of >40%.
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19
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Scalvini S, Bernocchi P, Villa S, Paganoni AM, La Rovere MT, Frigerio M. Treatment prescription, adherence, and persistence after the first hospitalization for heart failure: A population-based retrospective study on 100785 patients. Int J Cardiol 2021; 330:106-111. [PMID: 33582198 DOI: 10.1016/j.ijcard.2021.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study evaluates, in a real-world setting, to what extent the recommended therapies by international guidelines, are prescribed after a first hospitalization for heart failure (HF), and to analyse adherence and persistence, and the effect of treatment adherence on mortality and re-hospitalization. METHODS From the Lombardy healthcare administrative database, we analysed patients discharged after their incident HF, from 2000 to 2012. Adherence was defined as the proportion of days covered (PDC) ≥80% adjusted for hospitalizations and persistence as the absence of discontinuation of therapy for >30 days. A logit model was used to determine the effect of patients' adherence on mortality and readmissions. RESULTS Of 100422 HF patients (52% males, age 75 ± 12 years), 86846 (87%) had a prescription for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACE/ARBs), 64135 (64%) for beta-blockers (BB), and 36893 (37%) for mineralocorticoid receptor antagonists (MRAs), as mono-, bi- or tri-therapy. In patients on monotherapy, PDC was 78 ± 22% for ACE/ARBs, 69 ± 29% for BB and 54 ± 29% for MRAs; in those on bi-therapy, PDC was 63 ± 31% for ACEI/ARBs+BB, 41 ± 29% for ACEI/ARBs+MRAs, and 40 ± 26% for MRAs+BB; for patients on tri-therapy, PDC was 42 ± 28%. Medication persistence was present in 47% of patients treated with ACEI/ARBs, in 35% of patients treated with BB and in 14% of patients treated with MRAs. Re-hospitalizations and in mortality were significantly reduced in adherent patients (p < 0.000). CONCLUSIONS Polypharmacy is associated with an increased rate of non-adherence and non-persistence in incident HF. Non-adherence is associated with an increased risk of mortality and re-hospitalizations.
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Affiliation(s)
- Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiology Rehabilitation Department and Continuity Care Unit, Institute of Lumezzane (Brescia), Italy; Istituti Clinici Scientifici Maugeri IRCCS, Continuity Care Unit, Institute of Lumezzane (Brescia), Italy.
| | - Palmira Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity Care Unit, Institute of Lumezzane (Brescia), Italy
| | - Stefania Villa
- MOX - Department of Mathematics, Politecnico di Milano, Milan, Italy
| | | | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiology Rehabilitation Department, Institute of Montescano (Pavia), Italy
| | - Maria Frigerio
- De Gasperis Cardiocenter, Niguarda-Ca'Granda Hospital, Milan, Italy
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20
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Feldman SF, Lesuffleur T, Olié V, Gastaldi-Ménager C, Juillière Y, Tuppin P. French annual national observational study of 2015 outpatient and inpatient healthcare utilization by approximately half a million patients with previous heart failure diagnosis. Arch Cardiovasc Dis 2021; 114:17-32. [DOI: 10.1016/j.acvd.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
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21
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Fentie Wendie T, Tarekegn Angamo M. Drug-Therapy Problems and Predictors among Hospitalized Heart-Failure Patients: A Prospective Observational Study. Drug Healthc Patient Saf 2020; 12:281-291. [PMID: 33376412 PMCID: PMC7764776 DOI: 10.2147/dhps.s268923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/14/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Heart-failure patients are at high risk of experiencing drug-therapy problems, owing to polypharmacy, comorbidities, and usually advanced age. Drug-therapy problems can lead to poor clinical outcomes, increased health-care costs and decreased quality of life, and thus strategies for identifying, resolving, and preventing them are urgently needed. Therefore, this study aimed at investigating the incidence and predictors of drug-therapy problems among hospitalized heart-failure patients. METHODS This hospital-based prospective observational study was conducted from February 1 to May 31, 2014 at Jimma University Specialized Hospital. Patients of either sex aged 18 years and above with chronic heart failure and complete medical records were enrolled. Patients with high-output heart failure, <1 day of hospital stay, unwilling to give written informed consent, and unconscious without caregivers were excluded. Data were collected from medication charts, laboratory reports, patients/caregivers, morning multidisciplinary meetings, and ward rounds. Multivariate binary logistic regression analysis was done to identify independent predictors of drug-therapy problems. RESULTS A total of 104 heart-failure patients (mean age 51.20±15.66 years, females 51.9%) were consecutively enrolled, and 95 (91.3%) had experienced at least one drug-therapy problem (total 268, mean 2.82±1.39 encounters per patient). Of these problems, 45.5% were the need for additional drugs, followed by noncompliance (22.0%), inappropriate dosing (9.3%), unnecessary drugs (9.0%), ineffective drugs (8.2%), and adverse drug reactions (6.0%). None of the independent variables was found to be an independent predictor of having at least one drug-therapy problem. However, the number of clinical/pharmacological risk factors (AOR 7.93), female sex (AOR 3.24), and length of hospital stay (AOR 12.98) were predictors of noncompliance. CONCLUSION Patients suffered from a large number of drug-therapy problems. Drugs with survival benefit were underused. Noncompliance and the need for additional drug therapy were the most frequently identified drug-therapy problems. Numbers of clinical/pharmacological risk factors, length of hospital stay, and female sex were identified as predictors for noncompliance.
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Affiliation(s)
| | - Mulugeta Tarekegn Angamo
- Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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22
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Kalaitzidis RG, Panagiotopoulou T, Stagikas D, Pappas K, Balafa O, Elisaf MS. Arterial Stiffness, Cognitive Dysfunction and Adherence to Antihypertensive Agents. Is there a Link to Hypertensive Patients? Curr Vasc Pharmacol 2020; 18:410-417. [PMID: 30987567 DOI: 10.2174/1570161117666190415112953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/08/2019] [Accepted: 04/12/2019] [Indexed: 12/13/2022]
Abstract
The incidence of hypertension (HTN) and its cardiovascular (CV) complications are increasing throughout the world. Blood pressure (BP) control remains unsatisfactory worldwide. Medical inertia and poor adherence to treatment are among the factors that can partially explain, why BP control rate remains low. The introduction of a method for measuring the degree of adherence to a given medication is now a prerequisite. Complex treatment regimes, inadequate tolerance and frequent replacements of pharmaceutical formulations are the most common causes of poor adherence. In contrast, the use of stable combinations of antihypertensive drugs leads to improved patient adherence. We aim to review the relationships between arterial stiffness, cognitive function and adherence to medication in patients with HTN. Large artery stiffening can lead to HTN. In turn, arterial stiffness induced by HTN is associated with an increased CV and stroke risk. In addition, HTN can induce disorders of brain microcirculation resulting in cognitive dysfunction. Interestingly, memory cognitive dysfunction leads to a reduced adherence to drug treatment. Compliance with antihypertensive treatment improves BP control and arterial stiffness indices. Early treatment of arterial stiffness is strongly recommended for enhanced cognitive function and increased adherence.
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Affiliation(s)
- Rigas G Kalaitzidis
- Hypertension Excellence Centre, Division of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Thalia Panagiotopoulou
- Department of Internal Medicine, Medical School, University of Ioannina, 451 10, Ioannina, Greece
| | - Dimitrios Stagikas
- Department of Internal Medicine, Medical School, University of Ioannina, 451 10, Ioannina, Greece
| | - Kosmas Pappas
- Department of Internal Medicine, Medical School, University of Ioannina, 451 10, Ioannina, Greece
| | - Olga Balafa
- Hypertension Excellence Centre, Division of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Moses S Elisaf
- Department of Internal Medicine, Medical School, University of Ioannina, 451 10, Ioannina, Greece
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23
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Rasmussen AA, Wiggers H, Jensen M, Berg SK, Rasmussen TB, Borregaard B, Thrysoee L, Thorup CB, Mols RE, Larsen SH, Johnsen SP. Patient-reported outcomes and medication adherence in patients with heart failure. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:287-295. [PMID: 32761093 DOI: 10.1093/ehjcvp/pvaa097] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/31/2020] [Accepted: 07/31/2020] [Indexed: 11/14/2022]
Abstract
AIMS Patient-reported outcome measures (PROMs) may predict poor clinical outcome in patients with heart failure (HF). It remains unclear whether PROMs are associated with subsequent adherence to HF medication. We aimed to determine whether health-related quality of life, anxiety, and depression were associated with long-term medication adherence in these patients. METHODS AND RESULTS A national cohort study of Danish patients with HF with 3-year follow-up (n = 1464). PROMs included the EuroQol five-dimensional, five-level questionnaire (EQ-5D-5L), the HeartQoL and the Hospital Anxiety and Depression Scale (HADS). Patient-reported outcomes (PRO) data were linked to demographic and clinical data at baseline, and data on all redeemed prescriptions for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor neprilysin inhibitors (ACEI/ARB/ARNI), β-blockers, and mineralocorticoid receptor antagonists during follow-up. Medication non-adherence was defined as <80% of proportion of days covered. In adjusted regression analyses, lower health-related quality of life (EQ-5D and HeartQoL) and symptoms of depression (HADS-D) at discharge were associated with non-adherence. After 3 years of follow-up, lower health-related quality of life (EQ-5D) was associated with non-adherence for ACEI/ARB/ARNI [adjusted OR 2.78, 95% confidence interval (CI): 1.19-6.49], β-blockers (adjusted OR 2.35, 95% CI: 1.04-5.29), whereas HADS-D was associated with non-adherence for ACEI/ARB/ARNI (adjusted OR 1.07, 95% CI: 1.03-1.11) and β-blockers (adjusted OR 1.06, 95% CI: 1.02-1.10). CONCLUSION Lower health-related quality of life and symptoms of depression were associated with non-adherence across HF medications at 1 and 3 years of follow-up. Person-centred care using PROMs may carry a potential for identifying patients at increased risk of future medication non-adherence.
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Affiliation(s)
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Martin Jensen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | | | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense C, Denmark.,Department of Cardiology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Signe Holm Larsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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24
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Simpson J, Jackson CE, Haig C, Jhund PS, Tomaszewski M, Gardner RS, Tsorlalis Y, Petrie MC, McMurray JJV, Squire IB, Gupta P. Adherence to prescribed medications in patients with heart failure: insights from liquid chromatography-tandem mass spectrometry-based urine analysis. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:296-301. [PMID: 32597982 DOI: 10.1093/ehjcvp/pvaa071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/27/2020] [Accepted: 06/21/2020] [Indexed: 12/11/2022]
Abstract
AIMS None of the existing studies on adherence have directly measured levels of all medications (or their metabolites) in patients with heart failure (HF). METHODS AND RESULTS We used liquid chromatography-tandem mass spectrometry to measure the presence of prescribed drugs (diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists) in the urine of patients reviewed 4-6 weeks after hospitalization with HF. Patients were unaware that adherence was being assessed. Of the 341 patients studied, 281 (82.4%) were adherent, i.e. had all prescribed drugs of interest detectable in their urine. Conversely, 60 patients (17.6%) were partially or completely non-adherent. Notably, 24 of the 60 were non-adherent to only diuretic therapy and only seven out of all 341 patients studied (2.1%) were completely non-adherent to all prescribed HF drugs. There were no major differences in baseline characteristics between adherent and non-adherent patients. CONCLUSION Non-adherence, assessed using a single spot urine measurement of drug levels, was confirmed in one of five patients evaluated 4-6 weeks after hospitalization with HF.
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Affiliation(s)
- Joanne Simpson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - Colette E Jackson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - Caroline Haig
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow G12 8QQ, UK
| | - Pardeep S Jhund
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, AV Hill Building, Upper Brook Street, Manchester M13 9PT, UK.,Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Roy S Gardner
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - Yannis Tsorlalis
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.,National Institute of Health Research Leicester Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Pankaj Gupta
- Department of Cardiovascular Sciences, University of Leicester, NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.,Department of Chemical Pathology, University Hospitals of Leicester NHS Trust, Sandringham Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK
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25
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Shah M, Zimmer R, Kollefrath M, Khandwalla R. Digital Technologies in Heart Failure Management. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00643-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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26
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Qin X, Hung J, Teng THK, Briffa T, Sanfilippo FM. Long-Term Adherence to Renin-Angiotensin System Inhibitors and β-Blockers After Heart Failure Hospitalization in Senior Patients. J Cardiovasc Pharmacol Ther 2020; 25:531-540. [PMID: 32500739 DOI: 10.1177/1074248420931617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS We investigated long-term adherence to renin-angiotensin system inhibitors (RASIs) and β-blockers, and associated predictors, in senior patients after hospitalization for heart failure (HF). METHODS A population-based data set identified 4488 patients who survived 60 days following their index hospitalization for HF in Western Australia from 2003 to 2008 with a 3-year follow-up. Their person-linked Pharmaceutical Benefits Scheme records identified medications dispensed during follow-up. Drug discontinuation was defined as the first break ≥90 days following the previous supply. Medication adherence was calculated using the proportion of days covered (PDC), with PDC ≥ 80% defined as being adherent. Multivariable logistic regression models were used to identify predictors of PDC < 80%. RESULTS In the cohort (57% male, mean age: 76.6 years), 77.4% were dispensed a RASI and 52.7% a β-blocker within 60 days postdischarge. Over the 3-year follow-up, 28% and 42% of patients discontinued RASI and β-blockers, respectively. Only 64.6% and 47.5% of RASI and β-blocker users, respectively, were adherent to their treatment over 3 years, with adherence decreasing over time (trend P < .0001 for RASI and trend P = .02 for β-blockers). Older age, increasing Charlson comorbidity score, chronic kidney disease, and chronic obstructive pulmonary disease were independent predictors of PDC < 80% for both drug groups. CONCLUSION Among seniors hospitalized for HF, discontinuation gaps were common for RASI and β-blockers postdischarge, and long-term adherence to these medications was suboptimal. Where appropriate, strategies to improve long-term medication adherence are indicated in HF patients, particularly in elderly patients with comorbidities.
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Affiliation(s)
- Xiwen Qin
- School of Population and Global Health, 2720The University of Western Australia, Perth, Western Australia, Australia
| | - Joseph Hung
- Medical School, Sir Charles Gairdner Hospital Unit, 2720The University of Western Australia, Perth, Western Australia, Australia
| | - Tiew-Hwa Katherine Teng
- School of Population and Global Health, 2720The University of Western Australia, Perth, Western Australia, Australia
- 68753National Heart Centre Singapore, Singapore
| | - Tom Briffa
- School of Population and Global Health, 2720The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, 2720The University of Western Australia, Perth, Western Australia, Australia
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27
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Vonbank A, Agewall S, Kjeldsen KP, Lewis BS, Torp-Pedersen C, Ceconi C, Funck-Brentano C, Kaski JC, Niessner A, Tamargo J, Walther T, Wassmann S, Rosano G, Schmidt H, Saely CH, Drexel H. Comprehensive efforts to increase adherence to statin therapy. Eur Heart J 2019; 38:2473-2479. [PMID: 28077470 DOI: 10.1093/eurheartj/ehw628] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/06/2016] [Indexed: 12/26/2022] Open
Affiliation(s)
- Alexander Vonbank
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Stefan Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Keld Per Kjeldsen
- Division of Cardiology, Department of Medicine, Copenhagen University Hospital (Holbaek Hospital), Holbaek, Denmark.,Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Basil S Lewis
- Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine of the Technion (Israel Institute of Technology), Haifa, Israel
| | - Christian Torp-Pedersen
- Health Science and Technology, Aalborg University, Niels Jernes Vej 12, A5-208, 9220 Aalborg, Denmark
| | - Claudio Ceconi
- University Hospital of Ferrara, U.O. Cardiologia, Post Degree School in Cardiology, Heart Failure and Cardiovascular Prevention Unit, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Christian Funck-Brentano
- INSERM, CIC-1421 and UMR ICAN 1166, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology, Sorbonne Universités, UPMC Univ Paris, 06, Faculty of Medicine, F-75013 Paris, France
| | - Juan Carlos Kaski
- Cardiovascular Sciences Research Centre at St George's, University of London, Cranmer Terrace, London SW17 0RE, Great Britain
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Thomas Walther
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland.,Department of Obstetrics, Center for Perinatal Medicine, University of Leipzig, Leipzig, Germany
| | - Sven Wassmann
- Department of Cardiology, Isar Heart Center, Isarklinikum, Sonnenstr. 24-26, 80331 Munich, Germany
| | - Giuseppe Rosano
- Irccs San Raffaele Hospital, Department of Medical Sciences, Via Della Pisana 235, 00163 Rome, Italy
| | - Harald Schmidt
- Department of Health, Medicine and Life Sciences, Pharmacology, University of Maastricht Universiteitssingel 50, 6229 Maastricht, The Netzerlands
| | - Christoph H Saely
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Heinz Drexel
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein.,College of Medicine, Drexel University, Philadelphia, PA, USA
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28
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Papadimitriou L, Moore CK, Butler J, Long RC. The Limitations of Symptom-based Heart Failure Management. Card Fail Rev 2019; 5:74-77. [PMID: 31179015 PMCID: PMC6546002 DOI: 10.15420/cfr.2019.3.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) has emerged as a global epidemic and it affects about 6 million adults in the US. HF medical treatment, as recommended in guidelines, significantly improves survival and quality of life; however, the mortality burden of HF remains high. For decades, treatment has been guided, mainly by symptoms, leading to undertreatment in a range of settings. Current evidence emphasises the unfavourable outcomes of HF even in early stages or in patients who achieve reverse remodeling and remission or recovery under optimised treatment. This should stimulate efforts towards a more objective, rigorous management, covering the entire spectrum of mild, moderate and severe HF.
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Affiliation(s)
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson MS, US
| | - Robert C Long
- University of Mississippi Medical Center, Jackson MS, US
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29
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Pelouch R, Voříšek V, Furmanová V, Solař M. The Assessment of Serum Drug Levels to Diagnose Non-Adherence in Stable Chronic Heart Failure Patients. ACTA MEDICA (HRADEC KRÁLOVÉ) 2019; 62:52-57. [DOI: 10.14712/18059694.2019.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The aim of our study was to evaluate the prevalence of drug non-adherence in stable chronic heart failure (CHF) patients using serum drug levels (SDL) assessment. Methods: CHF patients were prospectively enrolled during scheduled outpatient visit. Except standard procedures an unanticipated blood sampling for the SDL assessment was obtained. Analysis was focused on the prescribed heart failure and antihypertensive medication and was performed by liquid chromatography coupled with mass spectrometry. The patient was labelled as non-adherent if at least one of drugs assessed was not found in the serum. In the first half of patients multiple SDL have been evaluated during the follow-up. Results: Eighty one patients were enrolled. The non-adherence was proven in twenty of them (25%). In the subgroup of thirty eight patients with multiple SDL evaluation the non-adherence raised significantly with increasing number of visits assessed together (21% for single visit, 29% for two of three visits assessed together and 34% for all three visits evaluated together, all p < 0.001). Conclusion: The non-adherence was proven in significant part of stable CHF patients using SDL assessment. This method seems to be reliable and effective and should be a part of clinical assessment in selected patients with CHF.
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Wachter R, Fonseca AF, Balas B, Kap E, Engelhard J, Schlienger R, Klebs S, Wirta SB, Kostev K. Real-world treatment patterns of sacubitril/valsartan: a longitudinal cohort study in Germany. Eur J Heart Fail 2019; 21:588-597. [PMID: 30972918 PMCID: PMC6607491 DOI: 10.1002/ejhf.1465] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/30/2019] [Accepted: 03/05/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS To analyse real-world treatment patterns of sacubitril/valsartan (sac/val) using data from a pharmacy database in Germany. METHODS AND RESULTS A retrospective cohort study of 26 191 adult patients (aged ≥ 18 years) in the IMS® longitudinal prescriptions database in Germany who were dispensed sac/val from January 2016 to June 2017 was conducted. The analysis included sac/val dose titration assessed in the 6 months from first sac/val prescription; prescriptions of concomitant cardiovascular medications in the 6 months pre- and post-index and compliance and persistence during 12 months post-index. Two-thirds of patients were prescribed the lowest sac/val dose of 50 mg twice daily (b.i.d.) at index and up-titration during the first 6 months was attempted in 41% of these patients. Ten percent of patients prescribed 200 mg b.i.d. at index had to be stably down-titrated; among patients prescribed 50 or 100 mg b.i.d. at index that were up-titrated, > 80% remained on the higher dose. Overall, the mean daily diuretic dose decreased by 25% after initiation of sac/val. High compliance and persistence rates were observed across sac/val doses, increasing with higher sac/val dose at index. Prior dose of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker had only minor impact on first sac/val dose, compliance and persistence. CONCLUSIONS Most patients prescribed sac/val are not initiated on the recommended dose nor up-titrated as recommended by the EU Summary of Product Characteristics. Initiation of sac/val was associated with high persistence and compliance and a dose reduction of diuretics. Barriers to up-titration must be explored.
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Affiliation(s)
- Rolf Wachter
- Clinic and Polyclinic for Cardiology, University Hospital Leipzig, Leipzig, Germany.,German Cardiovascular Research Center, Partner Site Göttingen, Göttingen, Germany
| | | | - Bogdan Balas
- Novartis Pharma AG, Basel, Switzerland.,F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Elisabeth Kap
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
| | | | | | - Sven Klebs
- Novartis Pharma GmbH, Nuremberg, Germany
| | | | - Karel Kostev
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
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Nakano A, Vinter N, Egstrup K, Svendsen ML, Schjødt I, Johnsen SP. Association between process performance measures and 1-year mortality among patients with incident heart failure: a Danish nationwide study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:28-34. [PMID: 30204858 DOI: 10.1093/ehjqcco/qcy041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 09/10/2018] [Indexed: 12/28/2022]
Abstract
Aims To examine the association between fulfilment of performance measures supported by clinical guidelines recommendations and 1-year mortality among patients with incident heart failure (HF) in Denmark. Methods and results A nationwide population-based follow-up study based on the Danish Heart Failure Registry. All Danish hospital departments caring for patients with HF. We identified 24 308 in- and outpatients diagnosed with HF from 2003 to 2010. Quality of care was defined as receiving the guideline recommended processes of care: use of echocardiography, New York Heart Association classification, treatment with angiotensin-converting-enzyme inhibitors/angiotensin-II-receptor blocker, beta blockers, physical training, and patient education. Main outcome measure is 1-year mortality. We used multiple imputation and multivariable Cox proportional hazard regression to compute hazard ratios (HRs) for 1-year mortality adjusted for potential confounding factors. Within 1 year, 17.1% of the patients died and the adjusted HRs ranged from 0.61 [95% confidence interval (CI) 0.55-0.67] for patient education to 0.99 (95% CI 0.90-1.10) for beta blocker therapy. The association between meeting more performance measures and 1-year mortality appeared to follow a dose-response pattern: using 0-25% of fulfilled measures as reference, patients who fulfilled 76-100% of the performance measures had an adjusted HR of 0.43 (95% CI 0.38-0.48), while the adjusted HR was 0.96 (95% CI 0.86-1.07) for patients who fulfilled between 26% and 50% of the performance measures. Conclusion Meeting process performance measures, which reflect care in concordance with clinical guideline recommendations, was associated with substantially lower 1-year mortality among patients with incident HF.
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Affiliation(s)
- Anne Nakano
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Olof Palmes Allé 43, Denmark.,Department of The Danish Clinical Registers, Audit Unit West, Olof Palmes Allé 15, Aarhus N, Denmark
| | - Nicklas Vinter
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Region Hospital, Falkevej 1G, Silkeborg, Denmark.,Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, Aalborg, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg Hospital, Baagøes Allé 15, Svendborg, Denmark
| | - Marie Louise Svendsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Olof Palmes Allé 43, Denmark.,Data & Documentation, DEFACTUM, Olof Palmes Allé 17, Aarhus N, Denmark
| | - Inge Schjødt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Olof Palmes Allé 43, Denmark.,Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, Aalborg, Denmark
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Jensen ASC, Polcwiartek C, Søgaard P, Mortensen RN, Davidsen L, Aldahl M, Eriksen MA, Kragholm K, Torp-Pedersen C, Hansen SM. The Association Between Serum Calcium Levels and Short-Term Mortality in Patients with Chronic Heart Failure. Am J Med 2019; 132:200-208.e1. [PMID: 30691552 DOI: 10.1016/j.amjmed.2018.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with chronic heart failure have vulnerable myocardial function and are susceptible to electrolyte disturbances. In these patients, diuretic treatment is frequently prescribed, though it is known to cause electrolyte disturbances. Therefore, we investigated the association between altered calcium homeostasis and the risk of all-cause mortality in chronic heart failure patients. METHODS From Danish national registries, we identified patients with chronic heart failure with a serum calcium measurement within a minimum 90 days after initiated treatment with both loop diuretics and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Patients were divided into 3 groups according to serum calcium levels, and Cox regression was used to assess the mortality risk of <1.18 mmol/L (hypocalcemia) and >1.32 mmol/L (hypercalcemia) compared with 1.18 mmol/L-1.32 mmol/L (normocalcemia) as reference. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. RESULTS Of 2729 patients meeting the inclusion criteria, 32.6% had hypocalcemia, 63.1% normocalcemia, and 4.3% hypercalcemia. The highest mortality risk was present in early deaths (≤30 days), with a HR of 2.22 (95% CI; 1.74-2.82) in hypocalcemic patients and 1.67 (95% CI; 0.96-2.90) in hypercalcemic patients compared with normocalcemic patients. As for late deaths (>30 days), a HR of 1.52 (95% CI; 1.12-2.05) was found for hypocalcemic patients and a HR of 1.87 (95% CI; 1.03-3.41) for hypercalcemic patients compared with normocalcemic patients. In adjusted analyses, hypocalcemia and hypercalcemia remained associated with an increased mortality risk in both the short term (≤30 days) and longer term (>30 days). CONCLUSION Altered calcium homeostasis was associated with an increased short-term mortality risk. Almost one-third of all the heart failure patients suffered from hypocalcemia, having a poor prognosis.
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Affiliation(s)
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark
| | - Peter Søgaard
- Department of Cardiology and Clinical Medicine Center for Cardiovascular Research, Aalborg University Hospital, Denmark
| | | | - Line Davidsen
- Department of Cardiology, Aalborg University Hospital, Denmark
| | - Mette Aldahl
- Department of Cardiology, Aalborg University Hospital, Denmark
| | | | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark; Department of Cardiology, Vendsyssel Regional Hospital, Hjørring, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark
| | - Steen Møller Hansen
- Department of Cardiology, Aalborg University Hospital, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark
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Lee JH, Kim MS, Yoo BS, Park SJ, Park JJ, Shin MS, Youn JC, Lee SE, Jang SY, Choi S, Cho HJ, Kang SM, Choi DJ. KSHF Guidelines for the Management of Acute Heart Failure: Part II. Treatment of Acute Heart Failure. Korean Circ J 2019; 49:22-45. [PMID: 30637994 PMCID: PMC6331324 DOI: 10.4070/kcj.2018.0349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 10/14/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022] Open
Abstract
The prevalence of heart failure (HF) is on the rise due to the aging of society. Furthermore, the continuous progress and widespread adoption of screening and diagnostic strategies have led to an increase in the detection rate of HF, effectively increasing the number of patients requiring monitoring and treatment. Because HF is associated with substantial rates of mortality and morbidity, as well as high socioeconomic burden, there is an increasing need for developing specific guidelines for HF management. The Korean guidelines for the diagnosis and management of chronic HF were introduced in March 2016. However, chronic and acute HF represent distinct disease entities. Here, we introduce the Korean guidelines for the management of acute HF with reduced or preserved ejection fraction. Part II of this guideline covers the treatment of acute HF.
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Affiliation(s)
- Ju Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Min Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Sung Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jong Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seok Min Kang
- Division of Cardiology, Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
The clinical syndrome of heart failure (HF) can be described as the reduced capacity of the heart to deliver blood throughout the body. To compensate for inadequate tissue perfusion, the renin–angiotensin aldosterone system (RAAS) and the sympathetic nervous system (SNS) become activated, resulting in increased blood pressure, heart rate, and blood volume. Consequent activation of the natriuretic peptide system (NPS) typically balances these effects; however, the NPS is unable to sustain compensation for excessive neurohormonal activation over time. Until recently, mortality benefits have been provided to patients with HF only by therapies that target the RAAS and SNS, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and beta-blockers. Sacubitril/valsartan, the first-in-class angiotensin receptor/neprilysin inhibitor (ARNI), targets both the NPS and RAAS to further improve clinical outcomes. This review discusses the focused management of patients with HF with reduced ejection fraction (HFrEF) and suggests changes to current management paradigms. From this assessment, the evidence supports favoring sacubitril/valsartan over ACEIs or ARBs, and this therapy should be used in conjunction with beta-blockers to further decrease morbidity and mortality in patients with HFrEF.
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Niriayo YL, Kumela K, Kassa TD, Angamo MT. Drug therapy problems and contributing factors in the management of heart failure patients in Jimma University Specialized Hospital, Southwest Ethiopia. PLoS One 2018; 13:e0206120. [PMID: 30352096 PMCID: PMC6198973 DOI: 10.1371/journal.pone.0206120] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 10/08/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Drug therapy problem (DTP) is any unwanted incident related to medication therapy that actually or potentially affects the desired goals of treatment. Heart failure (HF) patients are more likely to experience DTP owing to multiple prescriptions and comorbidities. Despite the serious negative impact of DTP on treatment outcomes, there is a dearth of study on DTP among HF patients in Ethiopia. OBJECTIVE The main aim of this study was to assess the prevalence and contributing factors of DTP among ambulatory HF patients in Jimma University Specialized Hospital, Ethiopia. METHODS A hospital based prospective observational study was conducted. Written informed consent was obtained from each patient after full explanation of the study. Data were collected through patient interview and expert review of medical, medication and laboratory records of one-year follow-up from May 2015 to April 2016. DTPs were identified using Cipolle's method followed by consensus review with experts. Binary logistic regression was performed to identify factors contributing to DTP. A p<0.05 was considered statistically significant in all analyses. RESULT Of 340 study participants; male to female ratio was equivalent, the mean (± SD = standard deviation) age was 50.5±15.6 years. Eight hundred eighty DTPs were identified equating 2.6 ±1.8 DTPs per patient. The frequently identified DTPs were dosage too low (27.8%), ineffective drug therapy (27.6%) and need additional drug therapy (27.4%). Most commonly implicated drugs were beta-blockers (34.4%), angiotensin converting enzyme inhibitors (24.8%), statins (16.5%) and antithrombotics (13.1%). Factors contributing to DTP were age >50 years (AOR [adjusted odd ratio] = 5.43, 95%CI [95% confidence interval] = 2.03-14.50); negative medication belief (AOR = 3.50, 95%CI = 1.22-10.05); poor involvement of patients in the therapeutic decision makings (AOR = 4.11, 95%CI = 1.91-8.88); number of co-morbidity≥2(AOR = 5.26, 95%CI = 2.38-11.65) and number of medications ≥5 (AOR = 3.68, 95%CI = 1.28-10.51). CONCLUSION DTPs are common among ambulatory care HF patients. Patients with older age, negative medication belief, polypharmacy, co-morbidities and those who were poorly involved in the therapeutic decision were more likely to experience DTP. Despite traditional prescription refilling, an integrated multidisciplinary approach involving patients and clinically trained pharmacists should be implemented in the patient care process at ambulatory care clinics in order to improve overall outcomes and reduce DTPs and associated burdens in HF patients.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy,College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kabaye Kumela
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromyia, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, School of Pharmacy,College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mulugeta Tarekegn Angamo
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromyia, Ethiopia
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobar, Australia
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Rankin A, Cadogan CA, Patterson SM, Kerse N, Cardwell CR, Bradley MC, Ryan C, Hughes C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2018; 9:CD008165. [PMID: 30175841 PMCID: PMC6513645 DOI: 10.1002/14651858.cd008165.pub4] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, hence interest in appropriate polypharmacy, where many medicines may be used to achieve better clinical outcomes for patients, is growing. This is the second update of this Cochrane Review. OBJECTIVES To determine which interventions, alone or in combination, are effective in improving the appropriate use of polypharmacy and reducing medication-related problems in older people. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers up until 7 February 2018, together with handsearching of reference lists to identify additional studies. SELECTION CRITERIA We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series. Eligible studies described interventions affecting prescribing aimed at improving appropriate polypharmacy in people aged 65 years and older, prescribed polypharmacy (four or more medicines), which used a validated tool to assess prescribing appropriateness. These tools can be classified as either implicit tools (judgement-based/based on expert professional judgement) or explicit tools (criterion-based, comprising lists of drugs to be avoided in older people). DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts of eligible studies, extracted data and assessed risk of bias of included studies. We pooled study-specific estimates, and used a random-effects model to yield summary estimates of effect and 95% confidence intervals (CIs). We assessed the overall certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS We identified 32 studies, 20 from this update. Included studies consisted of 18 randomised trials, 10 cluster randomised trials (one of which was a stepped-wedge design), two non-randomised trials and two controlled before-after studies. One intervention consisted of computerised decision support (CDS); and 31 were complex, multi-faceted pharmaceutical-care based approaches (i.e. the responsible provision of medicines to improve patient's outcomes), one of which incorporated a CDS component as part of their multi-faceted intervention. Interventions were provided in a variety of settings. Interventions were delivered by healthcare professionals such as general physicians, pharmacists and geriatricians, and all were conducted in high-income countries. Assessments using the Cochrane 'Risk of bias' tool, found that there was a high and/or unclear risk of bias across a number of domains. Based on the GRADE approach, the overall certainty of evidence for each pooled outcome ranged from low to very low.It is uncertain whether pharmaceutical care improves medication appropriateness (as measured by an implicit tool), mean difference (MD) -4.76, 95% CI -9.20 to -0.33; 5 studies, N = 517; very low-certainty evidence). It is uncertain whether pharmaceutical care reduces the number of potentially inappropriate medications (PIMs), (standardised mean difference (SMD) -0.22, 95% CI -0.38 to -0.05; 7 studies; N = 1832; very low-certainty evidence). It is uncertain whether pharmaceutical care reduces the proportion of patients with one or more PIMs, (risk ratio (RR) 0.79, 95% CI 0.61 to 1.02; 11 studies; N = 3079; very low-certainty evidence). Pharmaceutical care may slightly reduce the number of potential prescribing omissions (PPOs) (SMD -0.81, 95% CI -0.98 to -0.64; 2 studies; N = 569; low-certainty evidence), however it must be noted that this effect estimate is based on only two studies, which had serious limitations in terms of risk bias. Likewise, it is uncertain whether pharmaceutical care reduces the proportion of patients with one or more PPOs (RR 0.40, 95% CI 0.18 to 0.85; 5 studies; N = 1310; very low-certainty evidence). Pharmaceutical care may make little or no difference in hospital admissions (data not pooled; 12 studies; N = 4052; low-certainty evidence). Pharmaceutical care may make little or no difference in quality of life (data not pooled; 12 studies; N = 3211; low-certainty evidence). Medication-related problems were reported in eight studies (N = 10,087) using different terms (e.g. adverse drug reactions, drug-drug interactions). No consistent intervention effect on medication-related problems was noted across studies. AUTHORS' CONCLUSIONS It is unclear whether interventions to improve appropriate polypharmacy, such as reviews of patients' prescriptions, resulted in clinically significant improvement; however, they may be slightly beneficial in terms of reducing potential prescribing omissions (PPOs); but this effect estimate is based on only two studies, which had serious limitations in terms of risk bias.
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Affiliation(s)
- Audrey Rankin
- Queen's University BelfastSchool of Pharmacy97 Lisburn RoadBelfastNorthern IrelandUKBT9 7BL
| | - Cathal A Cadogan
- Royal College of Surgeons in IrelandSchool of PharmacyDublinIreland
| | - Susan M Patterson
- No affiliationIntegrated Care40 Dunmore RoadBallynahinchNorthern IrelandUKBT24 8PR
| | - Ngaire Kerse
- University of AucklandDepartment of General Practice and Primary Health CarePrivate Bag 92019AucklandNew Zealand
| | - Chris R Cardwell
- Queen's University BelfastCentre for Public HealthSchool of MedicineDentistry and Biomedical SciencesBelfastNorthern IrelandUKBT12 6BJ
| | - Marie C Bradley
- National Cancer Institute9609 Medical Center DriveRockvilleMDUSA20850
| | - Cristin Ryan
- Trinity College DublinSchool of Pharmacy and Pharmaceutical Sciences111 St Stephen’s GreenDublin 2Ireland
| | - Carmel Hughes
- Queen's University BelfastSchool of Pharmacy97 Lisburn RoadBelfastNorthern IrelandUKBT9 7BL
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Corletto A, Fröhlich H, Täger T, Hochadel M, Zahn R, Kilkowski C, Winkler R, Senges J, Katus HA, Frankenstein L. Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy. Clin Res Cardiol 2018; 107:1040-1049. [PMID: 29774407 DOI: 10.1007/s00392-018-1277-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate. METHODS AND RESULTS We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51-69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (p < 0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50-70 bpm (p = 0.054). CONCLUSIONS Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival.
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Affiliation(s)
- Anna Corletto
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Hanna Fröhlich
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Tobias Täger
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Matthias Hochadel
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Ralf Zahn
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Caroline Kilkowski
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Ralph Winkler
- Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Bremserstraße 79, 67063, Ludwigshafen am Rhein, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany.
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Abstract
PURPOSE OF REVIEW This review illustrates the dynamic role of palliative care in heart failure management and encapsulates the commonly utilized pharmacologic and non-pharmacologic therapeutic strategies for symptom palliation in heart failure. In addition, we provide our experience regarding patient care issues common to the domain of heart failure and palliative medicine which are commonly encountered by heart failure teams. RECENT FINDINGS Addition of palliative care to conventional heart failure management plan results in improvement in quality of life, anxiety, depression, and spiritual well-being among patients. Palliative care should not be confused with hospice care. Palliative care teams should be involved early in the care of heart failure patients with the aims of improving symptom palliation, discussing goals of care and improving quality of life without compromising utilization of evidence-based heart failure therapies. A consensus on the appropriate timing of involvement and evidence for many symptom palliation therapies is still emerging.
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Bassand JP, Accetta G, Al Mahmeed W, Corbalan R, Eikelboom J, Fitzmaurice DA, Fox KAA, Gao H, Goldhaber SZ, Goto S, Haas S, Kayani G, Pieper K, Turpie AGG, van Eickels M, Verheugt FWA, Kakkar AK. Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry: Rationale for comprehensive management of atrial fibrillation. PLoS One 2018; 13:e0191592. [PMID: 29370229 PMCID: PMC5784935 DOI: 10.1371/journal.pone.0191592] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/08/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The factors influencing three major outcomes-death, stroke/systemic embolism (SE), and major bleeding-have not been investigated in a large international cohort of unselected patients with newly diagnosed atrial fibrillation (AF). METHODS AND RESULTS In 28,628 patients prospectively enrolled in the GARFIELD-AF registry with 2-year follow-up, we aimed at analysing: (1) the variables influencing outcomes; (2) the extent of implementation of guideline-recommended therapies in comorbidities that strongly affect outcomes. Median (IQR) age was 71.0 (63.0 to 78.0) years, 44.4% of patients were female, median (IQR) CHA2DS2-VASc score was 3.0 (2.0 to 4.0); 63.3% of patients were on anticoagulants (ACs) with or without antiplatelet (AP) therapy, 24.5% AP monotherapy, and 12.2% no antithrombotic therapy. At 2 years, rates (95% CI) of death, stroke/SE, and major bleeding were 3.84 (3.68; 4.02), 1.27 (1.18; 1.38), and 0.71 (0.64; 0.79) per 100 person-years. Age, history of stroke/SE, vascular disease (VascD), and chronic kidney disease (CKD) were associated with the risks of all three outcomes. Congestive heart failure (CHF) was associated with the risks of death and stroke/SE. Smoking, non-paroxysmal forms of AF, and history of bleeding were associated with the risk of death, female sex and heavy drinking with the risk of stroke/SE. Asian race was associated with lower risks of death and major bleeding versus other races. AC treatment was associated with 30% and 28% lower risks of death and stroke/SE, respectively, compared with no AC treatment. Rates of prescription of guideline-recommended drugs were suboptimal in patients with CHF, VascD, or CKD. CONCLUSIONS Our data show that several variables are associated with the risk of one or more outcomes, in terms of death, stroke/SE, and major bleeding. Comprehensive management of AF should encompass, besides anticoagulation, improved implementation of guideline-recommended therapies for comorbidities strongly associated with outcomes, namely CHF, VascD, and CKD. TRIAL REGISTRATION ClinicalTrials.gov NCT01090362.
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Affiliation(s)
- Jean-Pierre Bassand
- Department of Cardiology–EA 3920, University of Besançon, Besançon, France
- Thrombosis Research Institute, London, United Kingdom
- * E-mail:
| | | | - Wael Al Mahmeed
- Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ramon Corbalan
- Department of Cardiology, Catholic University School of Medicine, Santiago, Chile
| | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Keith A. A. Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Haiyan Gao
- Thrombosis Research Institute, London, United Kingdom
| | - Samuel Z. Goldhaber
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shinya Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Kanagawa, Japan
| | - Sylvia Haas
- Formerly Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gloria Kayani
- Thrombosis Research Institute, London, United Kingdom
| | - Karen Pieper
- Thrombosis Research Institute, London, United Kingdom
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | | | | | - Freek W. A. Verheugt
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ajay K. Kakkar
- Thrombosis Research Institute, London, United Kingdom
- University College London, London, United Kingdom
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40
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Kayibanda JF, Girouard C, Grégoire JP, Demers E, Moisan J. Adherence to the evidence-based heart failure drug treatment: Are there sex-specific differences among new users? Res Social Adm Pharm 2017; 14:915-920. [PMID: 29089274 DOI: 10.1016/j.sapharm.2017.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The evidence-based heart failure (HF) drug treatment is made of a β-blocker and an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker, or hydralazine + isosorbide dinitrate. Little is known about sex-based difference in adherence to the evidence-based HF drug treatment. OBJECTIVES To assess among new users of the evidence-based HF drug treatment, the association between sex and 1) persistence with the treatment 1 year after its initiation, 2) implementation of the treatment among those who persisted, and 3) overall adherence to treatment in the year following its initiation. METHODS A cohort study was conducted among new users of this treatment using Quebec medico-administrative data. Patients still on the evidence-based HF drug treatment one year after initiation were considered persistent. Among persistent users, those with ≥88% of days covered by the treatment were deemed to have adequately implemented it. Persistent patients who have adequately implemented the treatment were considered adherent. To measure the association between, on one hand sex, and on the other persistence, implementation and adherence, adjusted proportion ratios (APR) with their 95% confidence intervals (CI) were calculated. RESULTS Among 13,453 women, 72.1% were persistent, 72.2% adequately implemented the treatment, and 52.8% were adherent. Among the 14,614 men, these proportions were 73.6%, 67.9% and 50.1%, respectively. Men were less likely than women to be adherent to their treatment (APR: 0.96, 95% CI: 0.94-0.99). CONCLUSION Among individuals initiating an evidence-based multi-drug treatment for HF, men are less likely than women to be adherent to this treatment.
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Affiliation(s)
- J F Kayibanda
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.
| | - C Girouard
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - J-P Grégoire
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - E Demers
- Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - J Moisan
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
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Das D, Savarese G, Dahlström U, Fu M, Howlett J, Ezekowitz JA, Lund LH. Ivabradine in Heart Failure: The Representativeness of SHIFT (Systolic Heart Failure Treatment With the IF Inhibitor Ivabradine Trial) in a Broad Population of Patients With Chronic Heart Failure. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004112. [PMID: 28903983 DOI: 10.1161/circheartfailure.117.004112] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/17/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The sinus node inhibitor ivabradine was approved for patients with heart failure (HF) after the ivabradine and outcomes in chronic HF (SHIFT [Systolic Heart Failure Treatment With the IF Inhibitor Ivabradine Trial]) trial. Our objective was to characterize the proportion of patients with HF eligible for ivabradine and the representativeness of the SHIFT trial enrollees compared with those in the Swedish Heart Failure Registry. METHODS AND RESULTS We examined 26 404 patients with clinical HF from the Swedish Heart Failure Registry and divided them into SHIFT type (left ventricular ejection fraction <40%, New York Heart Association class II-IV, sinus rhythm, and heart rate ≥70 beats per minute) and non-SHIFT type. Baseline characteristics and medication use were compared and change in eligibility over time was reported at 6 months and 1 year in a subset of patients. Overall, 14.2% (n=3741) of patients were SHIFT type. These patients were more likely to be younger, men, have diabetes mellitus, ischemic heart disease, lower left ventricular ejection fraction, and more recent onset HF (<6 months; all, P<0.001). Although 88.9% of SHIFT type and 88.5% of non-SHIFT type (P=0.421) were receiving selected β-blockers, only 58.8% and 67.3% (P<0.001) were on >50% of target dose. From those patients who had repeated visits within 6 months (n=5420) and 1 year (n=6840), respectively, 10.2% (n=555) and 10.6% (n=724) of SHIFT-type patients became ineligible, 77.3% (n=4188) and 77.3% (n=5287) remained ineligible, and 4.6% (n=252) and 4.9% (n=335) of non-SHIFT-type patients became eligible for initiation of ivabradine. CONCLUSIONS From the Swedish Heart Failure Registry, 14.2% of patients with HF were eligible for ivabradine. These patients more commonly were not receiving target β-blocker dose. Over time, a minority of patients became ineligible and an even smaller minority became eligible.
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Affiliation(s)
- Debraj Das
- From the Division of Cardiology, Department of Medicine (D.D., J.A.E.) and Canadian VIGOUR Centre (J.A.E.), University of Alberta, Edmonton, Canada; Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (G.S., L.H.L.); Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Sweden (U.D.); Section of Cardiology, Department of Medicine, Göteborg, Sweden (M.F.); Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (J.H.); and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Gianluigi Savarese
- From the Division of Cardiology, Department of Medicine (D.D., J.A.E.) and Canadian VIGOUR Centre (J.A.E.), University of Alberta, Edmonton, Canada; Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (G.S., L.H.L.); Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Sweden (U.D.); Section of Cardiology, Department of Medicine, Göteborg, Sweden (M.F.); Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (J.H.); and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Ulf Dahlström
- From the Division of Cardiology, Department of Medicine (D.D., J.A.E.) and Canadian VIGOUR Centre (J.A.E.), University of Alberta, Edmonton, Canada; Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (G.S., L.H.L.); Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Sweden (U.D.); Section of Cardiology, Department of Medicine, Göteborg, Sweden (M.F.); Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (J.H.); and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Michael Fu
- From the Division of Cardiology, Department of Medicine (D.D., J.A.E.) and Canadian VIGOUR Centre (J.A.E.), University of Alberta, Edmonton, Canada; Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (G.S., L.H.L.); Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Sweden (U.D.); Section of Cardiology, Department of Medicine, Göteborg, Sweden (M.F.); Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (J.H.); and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Jonathan Howlett
- From the Division of Cardiology, Department of Medicine (D.D., J.A.E.) and Canadian VIGOUR Centre (J.A.E.), University of Alberta, Edmonton, Canada; Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (G.S., L.H.L.); Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Sweden (U.D.); Section of Cardiology, Department of Medicine, Göteborg, Sweden (M.F.); Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (J.H.); and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Justin A Ezekowitz
- From the Division of Cardiology, Department of Medicine (D.D., J.A.E.) and Canadian VIGOUR Centre (J.A.E.), University of Alberta, Edmonton, Canada; Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (G.S., L.H.L.); Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Sweden (U.D.); Section of Cardiology, Department of Medicine, Göteborg, Sweden (M.F.); Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (J.H.); and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (L.H.L.).
| | - Lars H Lund
- From the Division of Cardiology, Department of Medicine (D.D., J.A.E.) and Canadian VIGOUR Centre (J.A.E.), University of Alberta, Edmonton, Canada; Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (G.S., L.H.L.); Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Sweden (U.D.); Section of Cardiology, Department of Medicine, Göteborg, Sweden (M.F.); Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (J.H.); and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
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Goldstein CM, Gathright EC, Gunstad J, A Dolansky M, Redle JD, Josephson R, Moore SM, Hughes JW. Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure. J Behav Med 2017; 40:602-611. [PMID: 28190133 PMCID: PMC5873320 DOI: 10.1007/s10865-017-9829-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/13/2017] [Indexed: 11/29/2022]
Abstract
Patients with heart failure (HF) take many medications to manage their HF and comorbidities, and 20-50% experience depression. Depressed individuals with more complex medication regimens may be at greater risk for poor adherence. The aim of this study was to assess depressive symptoms as a moderator of the relationship between medication regimen complexity and medication adherence in an observational study of patients with HF. In hierarchical linear regression with the final sample of 299, the interaction of medication regimen complexity and depressive symptoms predicted medication adherence, p < .05. For individuals with higher levels of depressive symptoms [1 standard deviation (SD) above the mean], more regimen complexity was associated with lower adherence. For individuals with low (1 SD below the mean) or average levels of depressive symptoms, regimen complexity was unrelated to medication adherence. Care management strategies, including pillboxes and caregiver involvement, may be valuable in HF patients with depression.
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Affiliation(s)
- Carly M Goldstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, 196 Richmond Street, Providence, RI, 02903, USA.
- The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, 02903, USA.
| | - Emily C Gathright
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
| | - Mary A Dolansky
- School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Joseph D Redle
- Summa Cardiovascular Institute, Akron City Hospital, Summa Health System, Akron, OH, 44307, USA
| | - Richard Josephson
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, 44106, USA
| | - Shirley M Moore
- School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
- Summa Cardiovascular Institute, Akron City Hospital, Summa Health System, Akron, OH, 44307, USA
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Rodgers JE, Thudium EM, Beyhaghi H, Sueta CA, Alburikan KA, Kucharska-Newton AM, Chang PP, Stearns SC. Predictors of Medication Adherence in the Elderly: The Role of Mental Health. Med Care Res Rev 2017; 75:746-761. [PMID: 29148336 DOI: 10.1177/1077558717696992] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aging population routinely has comorbid conditions requiring complicated medication regimens, yet nonadherence can preclude optimal outcomes. This study explored the association of adherence in the elderly with demographic, socioeconomic, and disease burden measures. Data were from the fifth visit (2011-2013) for 6,538 participants in the Atherosclerosis Risk in Communities Study, conducted in four communities. The Morisky-Green-Levine Scale measured self-reported adherence. Forty percent of respondents indicated some nonadherence, primarily due to poor memory. Logit regression showed, surprisingly, that persons with low reading ability were more likely to report being adherent. Better self-reported physical or mental health both predicted better adherence, but the magnitude of the association was greater for mental than for physical health. Compared with persons with normal or severely impaired cognition, mild cognitive impairment was associated with lower adherence. Attention to mental health measures in clinical settings could provide opportunities for improving medication adherence.
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Affiliation(s)
- Jo E Rodgers
- 1 Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC, USA
| | - Emily M Thudium
- 1 Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC, USA
| | - Hadi Beyhaghi
- 2 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
| | - Carla A Sueta
- 3 School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
| | - Khalid A Alburikan
- 4 College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Anna M Kucharska-Newton
- 2 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
| | - Patricia P Chang
- 3 School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
| | - Sally C Stearns
- 2 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
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Pellicori P, Urbinati A, Shah P, MacNamara A, Kazmi S, Dierckx R, Zhang J, Cleland JG, Clark AL. What proportion of patients with chronic heart failure are eligible for sacubitril-valsartan? Eur J Heart Fail 2017; 19:768-778. [DOI: 10.1002/ejhf.788] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/14/2017] [Accepted: 01/17/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Castle Hill Hospital; Hull York Medical School (at University of Hull); Kingston upon Hull UK
| | - Alessia Urbinati
- Department of Cardiology, Castle Hill Hospital; Hull York Medical School (at University of Hull); Kingston upon Hull UK
| | - Parin Shah
- Department of Cardiology, Castle Hill Hospital; Hull York Medical School (at University of Hull); Kingston upon Hull UK
| | - Alexandra MacNamara
- Department of Cardiology, Castle Hill Hospital; Hull York Medical School (at University of Hull); Kingston upon Hull UK
| | - Syed Kazmi
- Department of Cardiology, Castle Hill Hospital; Hull York Medical School (at University of Hull); Kingston upon Hull UK
| | - Riet Dierckx
- Department of Cardiology, Castle Hill Hospital; Hull York Medical School (at University of Hull); Kingston upon Hull UK
| | - Jufen Zhang
- Department of Cardiology, Castle Hill Hospital; Hull York Medical School (at University of Hull); Kingston upon Hull UK
| | - John G.F. Cleland
- Department of Cardiology, Castle Hill Hospital; Hull York Medical School (at University of Hull); Kingston upon Hull UK
- National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit; Royal Brompton & Harefield Hospitals, Imperial College; London UK
| | - Andrew L. Clark
- Department of Cardiology, Castle Hill Hospital; Hull York Medical School (at University of Hull); Kingston upon Hull UK
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Sørensen R, Jamie Nielsen B, Langtved Pallisgaard J, Ji-Young Lee C, Torp-Pedersen C. Adherence with oral anticoagulation in non-valvular atrial fibrillation: a comparison of vitamin K antagonists and non-vitamin K antagonists. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2017; 3:151-156. [DOI: 10.1093/ehjcvp/pvw048] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/03/2017] [Indexed: 11/12/2022]
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Qin X, Teng THK, Hung J, Briffa T, Sanfilippo FM. Long-term use of secondary prevention medications for heart failure in Western Australia: a protocol for a population-based cohort study. BMJ Open 2016; 6:e014397. [PMID: 27803111 PMCID: PMC5128762 DOI: 10.1136/bmjopen-2016-014397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Heart failure (HF) is a chronic, debilitating and progressive disease associated with high morbidity and mortality. Evidence-based medications (EBMs) are the cornerstone of management of patients with HF. In Australia, these EBMs are subsidised by the Commonwealth Government under the Pharmaceutical Benefits Scheme. Suboptimal dispensing and non-adherence to these EBMs have been observed in patients with HF. Our study will investigate trends in dispensing patterns, as well as adherence and persistence of EBMs for HF. We will also identify factors influencing these patterns and their impact on long-term clinical outcomes. METHODS AND ANALYSIS This whole population-based cohort study will use longitudinal data for people aged 65-84 years who were hospitalised for HF in Western Australia between 2003 and 2008. Linked state-wide and national data will provide patient-level information on medication dispensing, medical visits, hospitalisations and death. Drug dispensing trends will be described, drug adherence and persistence estimated and the association with all-cause/cardiovascular death and hospitalisations reported. ETHICS AND DISSEMINATION This project has received approvals from the Western Australian Department of Health Human Research Ethics Committee and the Western Australian Aboriginal Health Ethics Committee. Results will be published in relevant cardiology journals and presented at national and international conferences.
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Affiliation(s)
- Xiwen Qin
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Tiew-Hwa Katherine Teng
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
- National Heart Centre Singapore, Singapore, Singapore
| | - Joseph Hung
- Sir Charles Gairdner Hospital Unit, School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Tom Briffa
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
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Kueh SHA, Devlin G, Lee M, Doughty RN, Kerr AJ. Management and Long-Term Outcome of Acute Coronary Syndrome Patients Presenting with Heart Failure in a Contemporary New Zealand Cohort (ANZACS-QI 4). Heart Lung Circ 2016; 25:837-46. [PMID: 27132622 DOI: 10.1016/j.hlc.2015.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/19/2015] [Accepted: 10/07/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acute heart failure (HF) associated with an acute coronary syndrome (ACS) predicts adverse outcome. There have been important recent improvements in ACS management. Our aim was to describe the management and outcomes in those with and without HF in a contemporary ACS cohort. METHODS Consecutive patients presenting with ACS between 2007 and 2011 were enrolled in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. Outcomes and medication dispensing were obtained using anonymised linkage to national data sets. A summary pharmacotherapy measure of "quadruple therapy" was defined as dispensing of at least one agent from each of the four evidence-based classes - anti-platelet, statin, angiotensin converting enzyme inhibitor/angiotensin receptor blocker and beta blocker. RESULTS Of 3743 ACS patients 14% had acute HF. Acute heart failure patients were older (69.2±12.6 vs 62.3±12.8 years, p<0.001), less likely to have coronary angiography (66% vs 86%, p<0.001) and revascularisation (46% vs 62%, p<0.001). Immediate post-discharge quadruple therapy was higher for those with than without HF (61% vs 55%, p=0.02) but fell to similar levels by one-year (45% vs 53%, p=0.55). At four years follow-up nearly half of those presenting with ACS and HF had died. After adjustment, HF remained a strong predictor of death within 28 days (OR 2.9, 95%CI 1.5 - 5.5) and beyond 28 days (HR 1.8, 95%CI 1.5 - 2.3). CONCLUSION Acute heart failure complicating ACS is associated with heightened risk of short-term and long-term mortality. One in three ACS patients with HF did not have coronary angiography and less than half received quadruple therapy a year after presentation.
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Affiliation(s)
| | - Gerry Devlin
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Mildred Lee
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Rob N Doughty
- Department of Medicine, University of Auckland and Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
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48
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Arutyunov AG, Dragunov DO, Arutyunov GP, Sokolova AV. [Impact of the dosing of basic drugs on the risk of rehospitalization in patients with chronic heart failure]. TERAPEVT ARKH 2016; 88:29-34. [PMID: 26978606 DOI: 10.17116/terarkh201688129-34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To investigate the impact of doses of the drugs, which have been achieved during adjustment and account for less or more than 50% of the maximal therapeutic ones on the risk of rehospitalization. SUBJECTS AND METHODS The data of the Pavlov Register were used to assess the treatment of patients with chronic heart failure. To assess the risk of rehospitalization in relation of the dose of a drug, all the doses were represented in percentage terms depending on the maximum therapeutic one. RESULTS The risk of hospitalization during 6 months in the patients receiving angiotensin-converting enzyme inhibitors at a dose of 25% or less of the therapeutic one was 21.18% (odds ratio (OR), 1.41; 95% confidence interval (CI), 1.13-1.76), that at doses of 50 and 100% of the therapeutic one was 16% (OR, 0.71; 95% CI, 0.56-0.88) and 34% (OR, 0.51; 95% CI, 0.43-0.60), respectively. The risk of rehospitalization in the patients taking β-blockers at doses of 25, 50, and 100% of the therapeutic one was 26% (OR, 1.05; 95% CI, 0.94-1.17), 23% (OR, 0.902; 95% CI, 0.75-1.07), and 6.25% (OR, 0.19; 95% CI, 0.07-0.56), respectively. The combined analysis of the dose and use frequency of diuretics showed that the highest risk of rehospitalization turned was noted in the patients using a single dose of 100 mg of furosemide (4.2% of cases) once weekly and was as high as 39% (OR, 0.45; 95% CI, 1.04-1.98). CONCLUSION The risk of rehospitalization is largely determined by the dosing factor in outpatient settings. Increasing the doses during adjustment reduces the risk of rehospitalization.
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Affiliation(s)
- A G Arutyunov
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - D O Dragunov
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - G P Arutyunov
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A V Sokolova
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
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Böhm M, Lloyd SM, Ford I, Borer JS, Ewen S, Laufs U, Mahfoud F, Lopez‐Sendon J, Ponikowski P, Tavazzi L, Swedberg K, Komajda M. Non‐adherence to ivabradine and placebo and outcomes in chronic heart failure: an analysis from
SHIFT. Eur J Heart Fail 2016; 18:672-83. [DOI: 10.1002/ejhf.493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 12/13/2022] Open
Affiliation(s)
- Michael Böhm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III Homburg/Saar Germany
| | - Suzanne M. Lloyd
- Robertson Centre for Biostatistics University of Glasgow Glasgow UK
| | - Ian Ford
- Robertson Centre for Biostatistics University of Glasgow Glasgow UK
| | - Jeffrey S. Borer
- Division of Cardiovascular Medicine The Howard Gilman Institute for Heart Valve Diseases and the Schiavone Institute for Cardiovascular Translational Research, SUNY Downstate Medical Center Brooklyn and New York NY USA
| | - Sebastian Ewen
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III Homburg/Saar Germany
| | - Ulrich Laufs
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III Homburg/Saar Germany
| | - Felix Mahfoud
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III Homburg/Saar Germany
| | - Jose Lopez‐Sendon
- Hospital Universitario La PAZ, Cardiology Department Instituto de Investigation Madrid Spain
| | | | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation Cotignola Italy
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg Sweden
- National Heart and Lung Institute Imperial College London UK
| | - Michel Komajda
- Istitute of Cardiometabolism and Nutrition (ICAN) Pierre et Marie Curie Paris VI University, La Pitié‐Salpétrière Hospital Paris France
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50
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Kim S, Shin DW, Yun JM, Hwang Y, Park SK, Ko YJ, Cho B. Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications. Hypertension 2016; 67:506-12. [DOI: 10.1161/hypertensionaha.115.06731] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/08/2015] [Indexed: 12/28/2022]
Abstract
The importance of adherence to antihypertensive treatments for the prevention of cardiovascular disease has not been well elucidated. This study evaluated the effect of antihypertensive medication adherence on specific cardiovascular disease mortality (ischemic heart disease [IHD], cerebral hemorrhage, and cerebral infarction). Our study used data from a 3% sample cohort that was randomly extracted from enrollees of Korean National Health Insurance. Study subjects were aged ≥20 years, were diagnosed with hypertension, and started newly prescribed antihypertensive medication in 2003 to 2004. Adherence to antihypertensive medication was estimated as the cumulative medication adherence. Subjects were divided into good (cumulative medication adherence, ≥80%), intermediate (cumulative medication adherence, 50%–80%), and poor (cumulative medication adherence, <50%) adherence groups. We used time-dependent Cox proportional hazards models to evaluate the association between medication adherence and health outcomes. Among 33 728 eligible subjects, 670 (1.99%) died of coronary heart disease or stroke during follow-up. Patients with poor medication adherence had worse mortality from IHD (hazard ratio, 1.64; 95% confidence interval, 1.16–2.31;
P
for trend=0.005), cerebral hemorrhage (hazard ratio, 2.19; 95% confidence interval, 1.28–3.77;
P
for trend=0.004), and cerebral infarction (hazard ratio, 1.92; 95% confidence interval, 1.25–2.96;
P
for trend=0.003) than those with good adherence. The estimated hazard ratios of hospitalization for cardiovascular disease were consistent with the mortality end point. Poor medication adherence was associated with higher mortality and a greater risk of hospitalization for specific cardiovascular diseases, emphasizing the importance of a monitoring system and strategies to improve medication adherence in clinical practice.
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Affiliation(s)
- Soyeun Kim
- From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University,
| | - Dong Wook Shin
- From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University,
| | - Jae Moon Yun
- From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University,
| | - Yunji Hwang
- From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University,
| | - Sue K. Park
- From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University,
| | - Young-Jin Ko
- From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University,
| | - BeLong Cho
- From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University,
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