1
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Boxhammer E, Zauner S, Kraus J, Dinges C, Schernthaner C, Danmayr F, Kolbitsch T, Granitz C, Motloch LJ, Hammerer M, Lichtenauer M, Hoppe UC, Strohmer B. Harmonizing Heartbeats: The Mosaic of Cardiac Resynchronization Therapy Responders-A Comprehensive Exploration of Diverse Criteria and Predictors. J Clin Med 2024; 13:4938. [PMID: 39201080 PMCID: PMC11355773 DOI: 10.3390/jcm13164938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/11/2024] [Accepted: 08/19/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Heart failure (HF) remains a challenging healthcare issue necessitating innovative therapies like cardiac resynchronization-defibrillation therapy (CRT-D). However, the definition of a CRT-D response lacks uniformity, impeding effective clinical evaluation. This study explores diverse CRT-D responder definitions encompassing functional, echocardiographic and laboratory criteria. Materials & Methods: A single-center study involving 132 CRT-D patients scrutinized responder criteria including NYHA stage, LVEF increase and proBNP decrease. Statistical analyses such as Kaplan-Meier curves and Cox hazard regression were employed to evaluate responder characteristics and survival outcomes. Results: Responder rates varied across criteria, revealing nuanced patient profiles. CRT-D responders defined by NYHA decrease, LVEF increase or proBNP decrease exhibit improved survival rates after 2 and 3 years (p < 0.050). Young age, absence of recent myocardial infarction and normal right ventricular echocardiographic parameters emerge as predictors for positive response. In part, drug-based HF therapy correlates with increased responder rates. Cox regression identified LVEF ≥ 5% and proBNP decrease ≥ 25% as independent predictors of extended survival. Conclusions: CRT-D responder definitions exhibit considerable variability, emphasizing the need for a nuanced patient-centered approach. Factors like right ventricular function, drug therapy, atrial fibrillation and renal function influence responses. This study enriches our understanding of CRT-D response and contributes to the foundation for personalized HF management.
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Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
| | - Sophie Zauner
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
| | - Johannes Kraus
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
| | - Christian Dinges
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria;
| | - Christiana Schernthaner
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
| | - Franz Danmayr
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
| | - Tobias Kolbitsch
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
| | - Christina Granitz
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
| | - Lukas J. Motloch
- Department of Internal Medicine, Division of Cardiology, Nephrology and Intensive Care Medicine, Salzkammergut Clinic Vöcklabruck, 4840 Vöcklabruck, Austria;
| | - Matthias Hammerer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
| | - Bernhard Strohmer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria
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2
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Savarese G, Lindberg F, Cannata A, Chioncel O, Stolfo D, Musella F, Tomasoni D, Abdelhamid M, Banerjee D, Bayes-Genis A, Berthelot E, Braunschweig F, Coats AJS, Girerd N, Jankowska EA, Hill L, Lainscak M, Lopatin Y, Lund LH, Maggioni AP, Moura B, Rakisheva A, Ray R, Seferovic PM, Skouri H, Vitale C, Volterrani M, Metra M, Rosano GMC. How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024; 26:1278-1297. [PMID: 38778738 DOI: 10.1002/ejhf.3295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Guideline-directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF) reduces morbidity and mortality, but its implementation is often poor in daily clinical practice. Barriers to implementation include clinical and organizational factors that might contribute to clinical inertia, i.e. avoidance/delay of recommended treatment initiation/optimization. The spectrum of strategies that might be applied to foster GDMT implementation is wide, and involves the organizational set-up of heart failure care pathways, tailored drug initiation/optimization strategies increasing the chance of successful implementation, digital tools/telehealth interventions, educational activities and strategies targeting patient/physician awareness, and use of quality registries. This scientific statement by the Heart Failure Association of the ESC provides an overview of the current state of GDMT implementation in HFrEF, clinical and organizational barriers to implementation, and aims at suggesting a comprehensive framework on how to overcome clinical inertia and ultimately improve implementation of GDMT in HFrEF based on up-to-date evidence.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | - Felix Lindberg
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Cannata
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', and University of Medicine Carol Davila, Bucharest, Romania
| | - Davide Stolfo
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Francesca Musella
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Cardiology Department, Santa Maria delle Grazie Hospital, Naples, Italy
| | - Daniela Tomasoni
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy, Department of Cardiology, Cairo University, Cairo, Egypt
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, Cardiovascular and Genetics Research Institute, St George's University, London, UK
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias I Pujol, CIBERCV, Badalona, Spain
| | | | - Frieder Braunschweig
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | | | - Nicolas Girerd
- Centre d'Investigation Clinique Plurithémathique Pierre Drouin & Département de Cardiologie Institut Lorrain du Cœur et des Vaisseaux, Université de Lorraine, CHRU-Nancy, Vandœuvre-lès-Nancy, France
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University and Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Yury Lopatin
- Volgograd State Medical University, Regional Cardiology Centre, Volgograd, Russia
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Brenda Moura
- Armed Forces Hospital, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Amina Rakisheva
- City Cardiology Center, Konaev City Hospital, Almaty Region, Kazakhstan
| | - Robin Ray
- Department of Cardiology, St George's University Hospital, London, UK
| | - Petar M Seferovic
- University Medical Center, Medical Faculty University of Belgrade, Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Hadi Skouri
- Cardiology Division, Internal Medicine Department, Balamand University School of Medicine, Beirut, Lebanon
| | - Cristiana Vitale
- Department of Cardiology, St George's University Hospital, London, UK
| | - Maurizio Volterrani
- Department of Exercise Science and Medicine, San Raffaele Open University of Rome, Rome, Italy
- Cardiopulmonary Department, IRCCS San Raffaele Roma, Rome, Italy
| | - Marco Metra
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe M C Rosano
- Department of Cardiology, St George's University Hospital, London, UK
- Cardiology, San Raffaele Hospital, Cassino, Italy
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3
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Schjødt I, Mols RE, Eiskjær H, Bakos I, Horváth-Puhó E, Gustafsson F, Kristensen SL, Larsson JE, Løgstrup BB. Long-Term Medical Treatment and Adherence in Patients With Left Ventricular Assist Devices: A Danish Nationwide Cohort Study. ASAIO J 2023; 69:e482-e490. [PMID: 37792681 DOI: 10.1097/mat.0000000000002057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
The use of a left ventricular assist device (LVAD) in treating advanced heart failure has increased. However, data regarding medical treatment and adherence following LVAD implantation is sparse, particularly whether socioeconomic factors (cohabitation status, educational level, employment status, and income) and multimorbidity influence these aspects, which are known to impact adherence in heart failure patients. We performed a nationwide cohort study of 119 patients with LVAD implanted between January 1, 2006, and December 31, 2018, who were discharged alive with LVAD therapy. We linked individual-level data from clinical LVAD databases, the Scandiatransplant Database, and Danish medical and administrative registers. Medical treatment 90-day pre-LVAD and 720-day post-LVAD were assessed using descriptive statistics in 90-day intervals. Medication adherence (proportion of days covered ≥80%) was assessed 181- to 720-day post-LVAD. The proportions of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (88.7%), beta-blockers (67.0%), mineralocorticoid receptor antagonists (62.9%), warfarin (87.6%), and aspirin (55.7%) within 90-day post-LVAD were higher than pre-LVAD and were stable during follow-up. Medication adherence ranged from 86.7% (aspirin) to 97.8% (warfarin). Socioeconomic factors and multimorbidity did not influence medical medication use and adherence. Among LVAD patients, medical treatment and adherence are at high levels, regardless of socioeconomic background and multimorbidity.
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Affiliation(s)
- Inge Schjødt
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke E Mols
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Eiskjær
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - István Bakos
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | | | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Søren L Kristensen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Johan E Larsson
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Brian B Løgstrup
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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4
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Adamo M, Tomasoni D, Stolz L, Stocker TJ, Pancaldi E, Koell B, Karam N, Besler C, Giannini C, Sampaio F, Praz F, Ruf T, Pechmajou L, Neuss M, Iliadis C, Baldus S, Butter C, Kalbacher D, Lurz P, Melica B, Petronio AS, von Bardeleben RS, Windecker S, Butler J, Fonarow GC, Hausleiter J, Metra M. Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration. JACC Cardiovasc Interv 2023; 16:896-905. [PMID: 37100553 DOI: 10.1016/j.jcin.2023.01.362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Guideline-directed medical therapy (GDMT) optimization is mandatory before transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with secondary mitral regurgitation (SMR) and heart failure (HF) with reduced ejection fraction (HFrEF). However, the effect of M-TEER on GDMT is unknown. OBJECTIVES The authors sought to evaluate frequency, prognostic implications and predictors of GDMT uptitration after M-TEER in patients with SMR and HFrEF. METHODS This is a retrospective analysis of prospectively collected data from the EuroSMR Registry. The primary events were all-cause death and the composite of all-cause death or HF hospitalization. RESULTS Among the 1,641 EuroSMR patients, 810 had full datasets regarding GDMT and were included in this study. GDMT uptitration occurred in 307 patients (38%) after M-TEER. Proportion of patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was 78%, 89%, and 62% before M-TEER and 84%, 91%, and 66% 6 months after M-TEER (all P < 0.001). Patients with GDMT uptitration had a lower risk of all-cause death (adjusted HR: 0.62; 95% CI: 0.41-0.93; P = 0.020) and of all-cause death or HF hospitalization (adjusted HR: 0.54; 95% CI: 0.38-0.76; P < 0.001) compared with those without. Degree of MR reduction between baseline and 6-month follow-up was an independent predictor of GDMT uptitration after M-TEER (adjusted OR: 1.71; 95% CI: 1.08-2.71; P = 0.022). CONCLUSIONS GDMT uptitration after M-TEER occurred in a considerable proportion of patients with SMR and HFrEF and is independently associated with lower rates for mortality and HF hospitalizations. A greater decrease in MR was associated with increased likelihood for GDMT uptitration.
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Affiliation(s)
- Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Edoardo Pancaldi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Benedikt Koell
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou, and Paris Cardiovascular Research Center, INSERM U970, Paris, France
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes-Gutenberg-Universität, Mainz, Germany
| | - Louis Pechmajou
- Department of Cardiology, European Hospital Georges Pompidou, and Paris Cardiovascular Research Center, INSERM U970, Paris, France
| | - Michael Neuss
- Immanuel Heart Center Bernau, Brandenburg Medical School Theodor Fontane, Cardiology, Bernau, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Christian Butter
- Immanuel Heart Center Bernau, Brandenburg Medical School Theodor Fontane, Cardiology, Bernau, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Anna S Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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5
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Salimian S, Moghaddam N, Deyell MW, Virani SA, Bennett MT, Krahn AD, Andrade JG, Hawkins NM. Defining the gap in heart failure treatment in patients with cardiac implantable electronic devices. Clin Res Cardiol 2023; 112:158-166. [PMID: 36329250 DOI: 10.1007/s00392-022-02123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The use of guideline-directed medical therapy (GDMT) is poorly described in patients with heart failure and reduced ejection fraction (HFrEF) with cardiac resynchronization therapy (CRT) and/or implantable cardioverter defibrillators (ICDs). OBJECTIVE To define the eligibility, uptake, dose, contraindications, and barriers to uptake of contemporary medical therapy in this population. METHODS Retrospective analysis of consecutive adults with ICD and/or CRT attending two Canadian tertiary centre device clinics between 1 March and 31 May 2021. RESULTS From 1005 device clinic consultations, 227 (22.6%) patients with HFrEF and CRT and/or ICD were included. GDMT eligibility was high: beta-blockers (99.6%), mineralocorticoid receptor antagonists (MRA) (89.0%), angiotensin receptor-neprilysin inhibitors (ARNI) (84.6%), and sodium-glucose cotransporter-2 inhibitors (SGLT2I) (87.7%). Contraindications were rare: beta-blockers (0.4%), MRA (11.0%), ARNI (15.4%), and SGLT2I (12.3%). Uptake of GDMT was high for beta-blockers (97.4%) but low for other medications: MRA (63.0%), ARNI (46.7%), SGLT2I (22.9%). Except for SGLT2I (84.6%) and beta-blockers (57.9%), less than one-half of patients were prescribed target-doses of MRA (10.5%), and ARNI (47.7%). Of the visits, GDMT was already optimal in 16%, electrophysiologists acted in 33% (21% prescribed, 7% ordered investigations, 5% referred to heart function services), and in the remaining visits, optimization was either deferred to another cardiologist (20%) or no plan was mentioned (25%), besides other reasons (4%). CONCLUSION Despite broad eligibility for GDMT in patients with HFrEF and ICD/CRT, significant gaps in prescription and titration exist. Our results highlight the need to embed quality assurance initiatives in cardiac device clinics to improve HFrEF care.
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Affiliation(s)
- Samaneh Salimian
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Nima Moghaddam
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Marc W Deyell
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Sean A Virani
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Matthew T Bennett
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Jason G Andrade
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada.
- St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
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6
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Green PG, Herring N, Betts TR. What Have We Learned in the Last 20 Years About CRT Non-Responders? Card Electrophysiol Clin 2022; 14:283-296. [PMID: 35715086 DOI: 10.1016/j.ccep.2021.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although cardiac resynchronization therapy (CRT) has become well established in the treatment of heart failure, the management of patients who do not respond after CRT remains a key challenge. This review will summarize what we have learned about non-responders over the last 20 years and discuss methods for optimizing response, including the introduction of novel therapies.
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Affiliation(s)
- Peregrine G Green
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK; Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Level 0 John Radcliffe Hospital, Oxford, OX3 9DU, UK; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Neil Herring
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Timothy R Betts
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK; Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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7
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Fonseca A, Lima TDM, Fernandez-Llimos F, Castel-Branco MM, Figueiredo IV. Evaluation of Cardiovascular Pharmacotherapy Guideline Adherence and Risk Factor Control in Portuguese Community Pharmacy Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106170. [PMID: 35627707 PMCID: PMC9140328 DOI: 10.3390/ijerph19106170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
Abstract
Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Assessing the patients’ CVD risk, controlling the risk factors, and ensuring the guideline-adherent cardiovascular pharmacotherapy are crucial interventions to improve health outcomes. This study aimed to evaluate the potential of pharmacists to improve the adherence to pharmacotherapy guidelines and the achievement of risk factor goals among patients who attended a community pharmacy. Methods: We conducted a single-center cross-sectional study. We performed in-pharmacy point-of-care testing, blood pressure and anthropometric measurements, and reviewed patients’ pharmacotherapy, based on European Society of Cardiology guidelines. Results: Of the 333 patients, 63.1% were in the high/very high risk category, 91.9% showed at least two modifiable risk factors, and in 61.9% of patients the cardiovascular pharmacotherapy was non-adherent to the current guidelines, failing to reach treatment goals. The lipid-lowering therapy was the least guideline adherent, with a suboptimal use of statins. However, we found no statistically significant difference between the guideline-adherent and the non-adherent group in terms of risk factor control. The pharmacist recommended 603 interventions to adhere to the guidelines. Conclusions: Community pharmacists are able to identify opportunities to optimize cardiovascular pharmacotherapy and support the patients to achieve cardiovascular risk factor goals, based on evidence-based guidelines, contributing to the improvement of CVD management.
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Affiliation(s)
- Anabela Fonseca
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University Coimbra, 3000-548 Coimbra, Portugal; (A.F.); (M.M.C.-B.); (I.V.F.)
| | - Tácio de Mendonça Lima
- Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro, Seropédica 23897-090, RJ, Brazil
- Correspondence:
| | - Fernando Fernandez-Llimos
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
| | - Maria Margarida Castel-Branco
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University Coimbra, 3000-548 Coimbra, Portugal; (A.F.); (M.M.C.-B.); (I.V.F.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), 3000-548 Coimbra, Portugal
| | - Isabel Vitória Figueiredo
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University Coimbra, 3000-548 Coimbra, Portugal; (A.F.); (M.M.C.-B.); (I.V.F.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), 3000-548 Coimbra, Portugal
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8
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Leyva F, Boriani G. The Effect of Cardiac Resynchronization without a Defibrillator on Morbidity and Mortality: An Individual-Patient-Data Meta-Analysis of COMPANION and CARE-HF. Eur J Heart Fail 2022; 24:1091-1093. [PMID: 35570709 DOI: 10.1002/ejhf.2536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Francisco Leyva
- Aston Medical School, Aston University, Birmingham, United Kingdom.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
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9
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Salimian S, Deyell MW, Andrade JG, Chakrabarti S, Bennett MT, Krahn AD, Hawkins NM. Heart failure treatment in patients with cardiac implantable electronic devices: Opportunity for improvement. Heart Rhythm O2 2021; 2:698-709. [PMID: 34988519 PMCID: PMC8710628 DOI: 10.1016/j.hroo.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Heart failure and reduced ejection fraction (HFrEF) is the predominant indication for cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) implantation. The care gap and opportunity to optimize guideline-directed medical therapy (GDMT) is unclear. OBJECTIVE We sought to define uptake, eligibility, dose, and adherence to GDMT in patients with CRT/ICD and HFrEF. METHODS MEDLINE was searched from 2000 to July 2021 for major randomized trials, registries, and cohort studies evaluating GDMT in this population. Thirty-eight studies focused on medical therapy in patients with CRT/ICD devices (CRT = 23, ICD = 11, and both = 4). RESULTS In the pivotal device trials, ACEI/ARB and beta-blocker use was high (mean 94%, range 41%-99%; and 83%, range 27%-97%, respectively), but mineralocorticoid receptor antagonists were modest (mean 45%, range 32%-61%), in keeping with guidelines of that era. Similar results were found in observational registries. CRT was associated with beta-blocker uptitration, while the effects on ACEI/ARB were less consistent. For beta blockers, 57%-68% of patients were uptitrated, increasing the mean percent of target dose achieved by 24% from baseline to follow-up. In one study, adherence increased, for ACEI/ARB from 37% to 55% and beta blockers 34% to 58%. Only 1 study assessed potential eligibility at implant for sacubitril-valsartan (72%) or ivabradine (28%), and no study examined sodium-glucose cotransporter-2 inhibitors. Increased uptake, titration, and dose was associated with reduced mortality, hospitalization, and device therapies. CONCLUSION Patients with HFrEF and ICD/CRT are undertreated with respect to GDMT, and there is opportunity to optimize therapy to improve morbidity and mortality.
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Affiliation(s)
- Samaneh Salimian
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Marc W. Deyell
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Jason G. Andrade
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Santabhanu Chakrabarti
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Matthew T. Bennett
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Nathaniel M. Hawkins
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
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10
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Boriani G, De Ponti R, Guerra F, Palmisano P, Zanotto G, D'Onofrio A, Ricci RP. Sinergy between drugs and devices in the fight against sudden cardiac death and heart failure. Eur J Prev Cardiol 2020; 28:110-123. [PMID: 33624080 DOI: 10.1093/eurjpc/zwaa015] [Citation(s) in RCA: 11] [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: 05/14/2020] [Revised: 06/28/2020] [Accepted: 07/17/2020] [Indexed: 01/02/2023]
Abstract
The impact of sudden cardiac death (SCD) in heart failure (HF) patients is important and prevention of SCD is a reasonable and clinically justified endpoint if associated with a reduction in all-cause mortality. According to literature, in HF with reduced ejection fraction, only three classes of agents were found effective in reducing SCD and all-cause mortality: beta-blockers, mineralcorticoid receptor antagonists and, more recently, angiotensin-receptor neprilysin-inhibitors. In the PARADIGM trial that tested sacubitril/valsartan vs. enalapril, the 20% relative risk reduction in cardiovascular deaths obtained with sacubitril/valsartan was attributable to reductions in the incidence of both SCD and death due to HF worsening and this effect can be added to the known positive effect of implantable cardioverter-defibrillators in appropriately selected patients. In order to maximize the implementation of all the available treatments, patients with HF should be included in virtuous networks with a dialogue between all the physician involved, with commitment by all these physicians for appropriate decision-making on application of pharmacological and device treatments according to available evidence, as well as commitment for drug titration before and after device implant, taking advantage from remote monitoring, and with the safety of back up device therapy when indicated. There are potential synergistic effects of drug therapy, with all the therapies acting on neuro-hormonal and sympathetic activation, but specifically with sacubitril/valsartan, and device therapy, in particular cardiac resynchronization therapy, with added incremental benefits on positive cardiac remodelling, prevention of HF progression, and prevention of ventricular tachyarrhythmias.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo 71, 41121 Modena, Italy
| | - Roberto De Ponti
- Cardiovascular Department, Circolo Hospital, Università degli Studi dell'Insubria, Via Ravasi, 2, 21100 Varese, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital 'Ospedali Riuniti', Via Lodovico Menicucci, 6, 60121 Ancona, Italy
| | - Pietro Palmisano
- Cardiology Unit, 'Card. G. Panico' Hospital, Via Papa Pio X, 4, 73039 Tricase, Italy
| | - Gabriele Zanotto
- UFS Cardiologia Interventistica - Cardiologia Ospedale Mater Salutis, Via Carlo Gianella, 1, 37045 Legnago, Italy
| | - Antonio D'Onofrio
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Azienda Ospedaliera dei Colli - Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy
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11
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Shah BR, DerSarkissian M, Tsintzos SI, Xiao Y, May D, Lu X, Kinrich D, Davis E, Lefebvre P, Duh MS, Dasta JF. Adherence to heart failure management medications following cardiac resynchronization therapy. Curr Med Res Opin 2020; 36:199-207. [PMID: 31535559 DOI: 10.1080/03007995.2019.1670474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The purpose of this study is to assess the real-world impact of cardiac resynchronization therapy (CRT) on adherence to heart failure (HF) medications.Methods: MarketScan administrative health care claims data from 2008 to 2014 among patients with HF were used. The date of first CRT implantation served as the index date. Adherence to guideline-directed medical therapy (GDMT) classes were compared during pre- and post-index periods using proportion of days covered (PDC). Comparisons between the two periods were made using the Wilcoxon sign-rank test for continuous PDC and McNemar's test for dichotomized PDC.Results: Increases in medication adherence were observed for major classes of HF GDMT medications. Specifically, adherence to angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), beta blockers (BB), and furosemide increased by 22, 24, 32, and 28% (all p < .001), respectively, in the 12 months pre to 12 months post-CRT. Large increases between the pre- and post-CRT period were also observed when considering adherence as dichotomized PDC ≥0.80 in the 12 months pre- versus post-CRT.Conclusion: Adherence to HF medications significantly improved among HF patients post-CRT implantation. Further research is needed to better understand the underlying determinants of this effect, including whether the effect is attributable to factors such as enhanced patient monitoring and improved access to high-quality specialized HF care among patients receiving CRT.
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Affiliation(s)
- Bimal R Shah
- Duke University School of Medicine, Durham, NC, USA
- Livongo, Mountain View, CA, USA
| | | | | | | | - Damian May
- Medtronic Global CRHF Headquarters, Mounds View, MN, USA
| | - Xiaoxiao Lu
- Medtronic Global CRHF Headquarters, Mounds View, MN, USA
| | | | | | | | - Mei S Duh
- Analysis Group, Inc., Boston, MA, USA
| | - Joseph F Dasta
- College of Pharmacy, University of Texas, Austin, TX, USA
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12
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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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13
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Jorsal A, Pryds K, McMurray JJV, Wiggers H, Sommer A, Nielsen JC, Nielsen RR. Optimizing heart failure treatment following cardiac resynchronization therapy. Clin Res Cardiol 2019; 109:638-645. [DOI: 10.1007/s00392-019-01553-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/13/2019] [Indexed: 12/28/2022]
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14
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Dauw J, Martens P, Mullens W. CRT Optimization: What Is New? What Is Necessary? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:45. [PMID: 31342198 DOI: 10.1007/s11936-019-0751-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiac resynchronization therapy (CRT) has proven to improve quality of life, reduce heart failure hospitalization, and prolong life in selected heart failure patients with reduced ejection fraction, on optimal medical therapy and with electrical dyssynchrony. To ensure maximal benefit for CRT patients, optimization of care should be implemented. This begins with appropriate referring as well as selecting patients, knowing that the presence of left bundle branch block and QRS ≥ 150 ms is associated with the greatest reverse remodeling. The LV lead, preferably quadripolar, is best targeted in a postero-lateral position. After implantation, optimal device programming should aim for maximal biventricular pacing and in selected cases further electrical delay optimization might be of use. Even as important, is the implementation of thorough multidisciplinary heart failure care with medication uptitration, remote monitoring, rehabilitation, and patient education. The role of newer pacing strategies as endocardial or His-bundle pacing remains the subject of ongoing investigation.
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Affiliation(s)
- Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium.
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15
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Vacarescu C, Cozma D, Petrescu L, Dragan S, Mornos C, Crisan S, Feier H, Lazar MA, Cozlac RA, Luca CT. Exercise test is essential in LV-only fusion CRT pacing without right ventricle lead. Clin Interv Aging 2019; 14:969-975. [PMID: 31239651 PMCID: PMC6556564 DOI: 10.2147/cia.s206251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/20/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: Left ventricle (LV)-only pacing is non-inferior to biventricular pacing but permanent fusion pacing is needed to ensure cardiac resynchronization therapy (CRT) responsiveness. The role of systematic exercise testing (ET) in these patients has not been established. This study was designed to assess clinical and therapeutic implications (device programming/drugs) of systematic ET in patients requiring fusion-pacing CRT without an right ventricle (RV) lead. Methods: Consecutive patients with a right atrium/LV-only dual-chamber (DDD) pacing system were included. Prospective data were obtained: device interrogation, ET, and echocardiography at every 6-month follow-up visit. CRT assessment during ET included maximal heart rate, beat-to-beat echocardiography analysis of LV fusion pacing, LV loss of capture, and improvement in exercise capacity. If LV loss of capture or unsatisfactory LV fusion pacing occurred, reprogramming was individualized for each patient and ET redone. Results: A total of 55 patients (29 male) aged 62±11 years were included. During follow-up (39±18 months), a total of 235 ETs were performed, with mean exercise load 6.4±1.3 metabolic equivalents of task (118±35 W, maximal heart rate 119±17 beats/min). Twenty patients (36%) had inadequate pacing or loss of LV capture during ET, due to exceeding the maximum tracking rate (11%), chronotropic incompetence (7%), and LV pacing outside the fusion-pacing band (18%), caused by physiological shortening of the PR interval or exagerated LV preexcitation during maximum exercise. Post-ET CRT-device optimization included reprogramming of rate-adaptive atrioventricular interval (total decrease 23±8 ms), individualized programming of maximum tracking rate, or rate-response function. Drug optimization was performed in 32% of patients, and ET redone in 36%. Conclusion: In one of three ETs, an intervention in device and medication optimization was done to ensure a better outcome. Routine ET should be a standard approach to maximize fusion-pacing CRT response during follow-up.
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Affiliation(s)
- Cristina Vacarescu
- Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Dragos Cozma
- Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
- Cardiology Department, Institute of Cardiovascular Diseases, Timișoara, Romania
| | - Lucian Petrescu
- Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
- Cardiology Department, Institute of Cardiovascular Diseases, Timișoara, Romania
| | - Simona Dragan
- Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
- Cardiology Department, Institute of Cardiovascular Diseases, Timișoara, Romania
| | - Cristian Mornos
- Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
- Cardiology Department, Institute of Cardiovascular Diseases, Timișoara, Romania
| | - Simina Crisan
- Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
- Cardiology Department, Institute of Cardiovascular Diseases, Timișoara, Romania
| | - Horea Feier
- Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
- Cardiology Department, Institute of Cardiovascular Diseases, Timișoara, Romania
| | - Mihai-Andrei Lazar
- Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Ramona Alina Cozlac
- Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
- Cardiology Department, Institute of Cardiovascular Diseases, Timișoara, Romania
| | - Constantin Tudor Luca
- Cardiology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
- Cardiology Department, Institute of Cardiovascular Diseases, Timișoara, Romania
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16
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Agewall S. Adherence to guidelines and registry data. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 3:183-184. [PMID: 28922837 DOI: 10.1093/ehjcvp/pvx027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Stefan Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
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17
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AlTurki A, Proietti R, Alturki H, Dorian P, Healey JS, Greiss I, Kus T, Essebag V, Huynh T. Meta-Analysis Comparing Neurohumoral Antagonist Use in Patients ≥75 Years Versus <75 Years Receiving Cardiac Resynchronization Therapy. Am J Cardiol 2018; 121:975-980. [PMID: 29576235 DOI: 10.1016/j.amjcard.2018.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/23/2017] [Accepted: 01/04/2018] [Indexed: 12/31/2022]
Abstract
Neurohumoral antagonists are the foundation of heart failure therapy in patients with reduced left ventricular ejection fraction. Cardiac resynchronization therapy (CRT) has also been associated with improved outcomes in these patients. We aimed to evaluate the use of neurohumoral antagonists in patients ≥75 years compared with <75 years of age receiving CRT. We searched electronic databases, up to December 20, 2016 for all studies reporting medication use in patients ≥75 years and <75 years of age who received CRT. We used random-effects meta-analysis models to summarize the studies. We retained 12 studies (1 randomized trial and 11 observational studies) enrolling 5,728 ≥75 years old and 9,549 patients of <75 years old. There were lower use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers in patients ≥75 years compared with patients <75 years (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.47 to 0.74, p < 0.0001). In addition, there were lower use of mineralocorticoid receptor antagonists in patients ≥75 years compared with patients <75 years (OR 0.48, 95% CI 0.40 to 0.57, p < 0.0001). The use of β blockers was nonsignificantly lower in patients ≥75 years compared with patients <75 years (OR 0.70, 95% CI 0.47 to 1.03, p = 0.07). In conclusion, neurohumoral antagonists appeared to be underused in patients ≥75 years compared with patients <75 years receiving CRT. Consideration should be given to increase neurohumoral antagonism in patients ≥75 years referred for CRT.
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Affiliation(s)
- Ahmed AlTurki
- Division of Cardiology, McGill University Health Center, Quebec, Canada.
| | - Riccardo Proietti
- Cardiology Department, Morriston Hospital, Swansea University, Swansea, UK
| | - Hasan Alturki
- School of Medicine and Medical Science, University College Dublin. School of Medicine, Dublin, Ireland
| | - Paul Dorian
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Isabelle Greiss
- Division of Cardiology, Montreal University Hospital Center, Montreal, Quebec, Canada
| | - Teresa Kus
- Division of Cardiology, Hopital de Sacre Coeur & Department of Pharmacology & Physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Quebec, Canada
| | - Thao Huynh
- Division of Cardiology, McGill University Health Center, Quebec, Canada
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18
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Massoullié G, Chouki C, Mulliez A, Rossignol P, Ploux S, Pereira B, Reuillard A, Jean F, Andronache M, Eschalier A, Motreff P, Clerfond G, Bordachar P, Authier N, Eschalier R. Effect of Optimization of Medical Treatment on Long-Term Survival of Patients With Heart Failure After Implantable Cardioverter Defibrillator and Cardiac Resynchronization Device Implantation (from the French National EGB Database). Am J Cardiol 2018; 121:725-730. [PMID: 29402420 DOI: 10.1016/j.amjcard.2017.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/03/2017] [Accepted: 12/11/2017] [Indexed: 11/16/2022]
Abstract
Prognosis of heart failure with reduced ejection fraction (HFrEF) is improved by drug optimization according to guidelines; however, little is known regarding such optimization in HFrEF patients with an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT). This study aimed to describe implementation of this optimized strategy and its impact in patients implanted with an ICD/CRT. Using a 1/97th representative sample of the French national health-care insurance system claims database, a retrospective cohort study was conducted including HFrEF patients implanted with ICD or CRT between January 2009 and December 2014. HFrEF treatments were analyzed before and after ICD/CRT implantation. Heart failure (HF) hospitalization and survival were examined at 1, 3, and 5 years: 378 patients (135 CRT, 243 ICD) with a mean age of 68 ± 13 years were included. Mean follow-up was 23 months [11-42]. At baseline, 36% of patients had no or only 1 HFrEF drug among β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and mineralocorticoid receptor antagonists, whereas 26% of patients received an optimal treatment (all 3 classes). At 3 months after ICD/CRT implantation, the prescription rate of HFrEF drugs was higher than baseline but returned to preimplantation levels at the end of follow-up. HF hospitalization rate was higher in the nonoptimized patient group (28% vs 14%, p = 0.001). Optimal HFrEF treatment was associated with better survival (hazard ratio = 0.59 [0.4-0.86], p = 0.006). In conclusion, HFrEF drugs are underprescribed before and after ICD/CRT implantation despite the demonstration that HFrEF drug optimization also reduces death and HF hospitalization in this population.
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Affiliation(s)
- Grégoire Massoullié
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Chenaf Chouki
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Aurélien Mulliez
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Patrick Rossignol
- INSERM, UMR-1116, Nancy, France; Faculty of Medicine, Université de Lorraine, Nancy, France; CHRU-Nancy, Hôpitaux de BRABOIS, Service de Médecine Nucléaire, Vandœuvre, France; INI-CRCT F-CRIN, Nancy, France
| | - Sylvain Ploux
- INSERM, UMR-1116, Nancy, France; Faculty of Medicine, Université de Lorraine, Nancy, France; CHRU-Nancy, Hôpitaux de BRABOIS, Service de Médecine Nucléaire, Vandœuvre, France; Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Bruno Pereira
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Adrien Reuillard
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Fréderic Jean
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Marius Andronache
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Pascal Motreff
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Guillaume Clerfond
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Romain Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France; INI-CRCT F-CRIN, Nancy, France.
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Sargento L, Simões AV, Longo S, Lousada N, Dos Reis RP. Treatment with Optimal Dose Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Has a Positive Effect on Long-Term Survival in Older Individuals (Aged >70 Years) and Octogenarians with Systolic Heart Failure. Drugs Aging 2017; 33:675-83. [PMID: 27568454 DOI: 10.1007/s40266-016-0393-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Heart failure with reduced ejection fraction (HFrEF) is a disease of older people, but the target doses of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are unknown. OBJECTIVE To evaluate the association of ACEI/ARB dose level with long-term survival in stable older patients (aged >70 years) and octogenarian outpatients with HFrEF. POPULATION AND METHODS A total of 138 outpatients aged >70 years (35.5 % > 80 years), with an LVEF <40 % and who were clinically stable on optimal therapy were followed up for 3 years. The ACEI/ARB doses were categorized as: none (0), low (1-50 % target dose), and high (50-100 % target dose). The Cox regression survival model was adjusted for age, ischemic etiology, and renal function. RESULTS ACEIs/ARBs were prescribed to 91.3 % of patients, and 52.9 % received the high dose. Survival improved with increasing ACEI/ARB dose level in the total population (Hazard Ratio [HR] = 0.67; 95 % confidence interval [CI] 0.55-0.82; p < 0.001), older patients aged >70 years (HR = 0.65; 95 % CI 0.51-0.83; p < 0.001), and octogenarians (HR = 0.71; 95 % CI 0.51-0.99; p = 0.045). The low (HR = 0.35; 95 % CI 0.16-0.76; p = 0.008) and high doses (HR = 0.13; 95 % CI 0.06-0.32; p < 0.001) improved survival compared with not receiving ACEIs/ARBs. The high dose was associated with a better survival than the low dose in the total population (HR = 0.35; 95 % CI 0.19-0.67; p = 0.001) and in a propensity score-matched cohort (HR = 0.41; 95 % CI 0.16-1.02; p = 0.056). In octogenarians, all dose levels were associated with improved survival compared with not receiving ACEIs/ARBs, but there was no difference between ACEI/ARB doses. CONCLUSION The achieved optimal dose of ACEIs/ARBs in ambulatory older people with HFrEF is associated with long-term survival.
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Affiliation(s)
- Luis Sargento
- Heart Failure Unit, Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Alameda Linhas de Torres, 1769-001, Lisboa, Portugal.
| | - Andre Vicente Simões
- Department of Internal Medicine, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal
| | - Susana Longo
- Heart Failure Unit, Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Alameda Linhas de Torres, 1769-001, Lisboa, Portugal
| | - Nuno Lousada
- Heart Failure Unit, Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Alameda Linhas de Torres, 1769-001, Lisboa, Portugal
| | - Roberto Palma Dos Reis
- Heart Failure Unit, Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Alameda Linhas de Torres, 1769-001, Lisboa, Portugal
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Cardiovascular pharmacotherapy. Int J Cardiol 2016; 224:412-415. [PMID: 27690338 DOI: 10.1016/j.ijcard.2016.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/16/2016] [Indexed: 11/21/2022]
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Lewis BS. Cardiovascular pharmacotherapy-2015 was a good year. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2016; 2:209-11. [PMID: 27600902 DOI: 10.1093/ehjcvp/pvw020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Basil S Lewis
- Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Volpe M, Francia P. Synergistic effects of cardiac resynchronization therapy and drug up-titration in heart failure: is this enough? EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:189-90. [DOI: 10.1093/ehjcvp/pvv022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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