Annual Evolution of the Prescription of Drugs with Prognostic Implications in Acute Decompensated Heart Failure with Reduced Ejection Fraction

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2024 Feb 14

PMID 38355445

Authors

Raquel Lopez-Vilella

Victor DonosoTrenado

Borja Guerrero Cervera

Ignacio Sanchez-Lazaro

Luis Martinez Dolz

Luis Almenar Bonet

Affiliations

Soon will be listed here.

Abstract

Background: Quadruple therapy (renin angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists and sodium/glucose cotransporter type 2 inhibitors [SGLT2i]) has become the current prognostic modifying treatment for heart failure (HF) with reduced ejection fraction (HFrEF). This study aimed to analyse the prescription´s evolution of this combination therapy, the analysis of each pharmacological group and the differences according to HF subgroups.

Methods: Retrospective analysis of consecutive patients admitted for cardiac decompensation. Inclusion period: from 1-1-2020 to 12-31-2022. Patients with left ventricular ejection fraction > 40% and deceased during admission were excluded. Finally, 602 patients were included. These were divided into: (a) de novo HF without previous heart disease (n:108), (b) de novo with previous heart disease (n:107), and (c) non-de novo (n:387).

Results: Over the study time, all pharmacological groups experienced an increase in drugs prescription (p < 0.001). The group with the largest prescription rate increase was SGLT2i (2020:20%, 2021:42.9%, 2022:70.4%; mean increase 47.2%). The discharge rate prescription of quadruple therapy increased progressively (2020:7.4%, 2021:21.1%, 2022:32.5%; mean increase 21.9%). The subgroup with the highest combined prescription in 2022 was de novo with previous heart disease (43.9%).

Conclusion: The pharmacological group with the largest prescription´s rate increase was SGLT2i. The percentage of patients discharged on quadruple therapy has progressed significantly in recent years, although it remains low. The most optimised subgroup at discharge was that of de novo HF with previous heart disease.

References

Adamo M, Gardner R, McDonagh T, Metra M . The 'Ten Commandments' of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 43(6):440-441. DOI: 10.1093/eurheartj/ehab853. View

Balmforth C, Simpson J, Shen L, Jhund P, Lefkowitz M, Rizkala A . Outcomes and Effect of Treatment According to Etiology in HFrEF: An Analysis of PARADIGM-HF. JACC Heart Fail. 2019; 7(6):457-465. DOI: 10.1016/j.jchf.2019.02.015. View

Malgie J, Clephas P, Brunner-La Rocca H, de Boer R, Brugts J . Guideline-directed medical therapy for HFrEF: sequencing strategies and barriers for life-saving drug therapy. Heart Fail Rev. 2023; 28(5):1221-1234. PMC: 10403394. DOI: 10.1007/s10741-023-10325-2. View

Heerspink H, Stefansson B, Correa-Rotter R, Chertow G, Greene T, Hou F . Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020; 383(15):1436-1446. DOI: 10.1056/NEJMoa2024816. View

Pranata R, Tondas A, Yonas E, Vania R, Yamin M, Chandra A . Differences in clinical characteristics and outcome of de novo heart failure compared to acutely decompensated chronic heart failure - systematic review and meta-analysis. Acta Cardiol. 2020; 76(4):410-420. DOI: 10.1080/00015385.2020.1747178. View

Voors A, Angermann C, Teerlink J, Collins S, Kosiborod M, Biegus J . The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat Med. 2022; 28(3):568-574. PMC: 8938265. DOI: 10.1038/s41591-021-01659-1. View

Wachter R, Senni M, Belohlavek J, Straburzynska-Migaj E, Witte K, Kobalava Z . Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail. 2019; 21(8):998-1007. DOI: 10.1002/ejhf.1498. View

Straw S, McGinlay M, Relton S, Koshy A, Gierula J, Paton M . Effect of disease-modifying agents and their association with mortality in multi-morbid patients with heart failure with reduced ejection fraction. ESC Heart Fail. 2020; 7(6):3859-3870. PMC: 7754757. DOI: 10.1002/ehf2.12978. View

Lopez-Vilella R, Donoso Trenado V, Guerrero Cervera B, Sanchez-Lazaro I, Almenar Bonet L . Sodium-glucose cotransporter 2 inhibitors reduce cardiovascular events in acute heart failure. A real-world analysis. Eur J Intern Med. 2022; 104:128-130. DOI: 10.1016/j.ejim.2022.06.008. View

10.

Jensen J, Poulsen M, Petersen P, Gerdes B, Rossing K, Schou M . Prevalence of heart failure phenotypes and current use of therapies in primary care: results from a nationwide study. ESC Heart Fail. 2023; 10(3):1745-1756. PMC: 10192278. DOI: 10.1002/ehf2.14324. View

11.

McMurray J, Solomon S, Inzucchi S, Kober L, Kosiborod M, Martinez F . Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019; 381(21):1995-2008. DOI: 10.1056/NEJMoa1911303. View

12.

McMurray J, Packer M, Desai A, Gong J, Lefkowitz M, Rizkala A . Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014; 371(11):993-1004. DOI: 10.1056/NEJMoa1409077. View

13.

Buddeke J, Valstar G, van Dis I, Visseren F, Rutten F, den Ruijter H . Mortality after hospital admission for heart failure: improvement over time, equally strong in women as in men. BMC Public Health. 2020; 20(1):36. PMC: 6954619. DOI: 10.1186/s12889-019-7934-3. View

14.

Scicchitano P, Iacoviello M, Massari F, De Palo M, Caldarola P, Mannarini A . Optimizing Therapies in Heart Failure: The Role of Potassium Binders. Biomedicines. 2022; 10(7). PMC: 9313061. DOI: 10.3390/biomedicines10071721. View

15.

Vaduganathan M, Greene S, Zhang S, Solomon N, Chiswell K, DeVore A . Projected Clinical Benefits of Implementation of SGLT-2 Inhibitors Among Medicare Beneficiaries Hospitalized for Heart Failure. J Card Fail. 2021; 28(4):554-563. DOI: 10.1016/j.cardfail.2021.11.010. View

16.

Packer M, Anker S, Butler J, Filippatos G, Pocock S, Carson P . Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020; 383(15):1413-1424. DOI: 10.1056/NEJMoa2022190. View

17.

Mebazaa A, Davison B, Chioncel O, Cohen-Solal A, Diaz R, Filippatos G . Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022; 400(10367):1938-1952. DOI: 10.1016/S0140-6736(22)02076-1. View

18.

Lopez-Vilella R, Jover Pastor P, Donoso Trenado V, Sanchez-Lazaro I, Barge Caballero E, Crespo-Leiro M . Mortality After the First Hospital Admission for Acute Heart Failure, De Novo Versus Acutely Decompensated Heart Failure With Reduced Ejection Fraction. Am J Cardiol. 2023; 196:59-66. DOI: 10.1016/j.amjcard.2023.03.008. View

19.

Kondo T, Jhund P, McMurray J . Drug therapy for heart failure with reduced ejection fraction: what is the 'right' dose?. Eur J Heart Fail. 2022; 24(3):421-430. PMC: 9303189. DOI: 10.1002/ejhf.2447. View

20.

Savarese G, Kishi T, Vardeny O, Adamsson Eryd S, Bodegard J, Lund L . Heart Failure Drug Treatment-Inertia, Titration, and Discontinuation: A Multinational Observational Study (EVOLUTION HF). JACC Heart Fail. 2022; 11(1):1-14. DOI: 10.1016/j.jchf.2022.08.009. View