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Carigi S, Gentile P, Gori M, Tinti D, De Gennaro L, Leonardi G, Orso F, Felici AR, Catalano MR, Floresta M, Rizzello V, Lucci D, Gonzini L, De Maria R, Marini M. Clinical characteristics, treatment, trajectories and outcome of patients with dilated cardiomyopathy in a national heart failure registry. Int J Cardiol 2024; 407:131986. [PMID: 38513737 DOI: 10.1016/j.ijcard.2024.131986] [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: 01/02/2024] [Revised: 02/23/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Available data on the clinical characteristics and prognosis of patients with heart failure (HF) due to dilated cardiomyopathy (DCM) derive mainly from tertiary care centres for cardiomyopathies or from drug trial sub-studies, which may entail a referral bias. METHODS From 2008 to 2021, we enrolled in a nationwide HF Registry 1886 DCM patients and 3899 with ischemic heart disease (IHD). RESULTS Patients with DCM were younger, more often female, had more commonly recent onset HF, left bundle branch block, and showed higher LV end-diastolic volume and lower LVEF than IHD. With respect to IHD, DCM patients received more often mineralocorticoid receptor antagonists, renin angiotensin system inhibitors and betablockers, the latter more commonly at doses ≥50% of target, and triple guideline-directed medical therapy (GDMT) (adjusted OR 1.411, 95% CI 1.247-1.595, p < .0001). During one-year follow-up, 819 patients (14.2%) died or were hospitalized for HF [187 (9.9%) DCM, 632 (16.2%) IHD]; DCM was associated with lower risk of the combined end-point (adjusted HR 0.745, 95% CI 0.625- 0.888, p = .0011). Among the 1954 patients with 1-year echocardiograms available, 1483 had LVEF≤40% at baseline; of these,166 (30.6%) DCM and 165 (17.5%) IHD improved their LVEF to >40% (p < .0001). DCM aetiology was associated with higher likelihood of LVEF improvement (adjusted OR 1.722, 95% CI 1.328 -2.233, p < .0001). CONCLUSIONS DCM patients have a different clinical profile, greater uptake of GDMT and better outcomes than IHD subjects. A comprehensive management approach is needed to further address the risk of unfavorable outcomes in DCM.
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Affiliation(s)
- Samuela Carigi
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Cardiology Unit, Infermi Hospital, Rimini, Italy
| | - Piero Gentile
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; De Gasperis Cardio ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro Gori
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Cardiology Division, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Denitza Tinti
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Unit of Cardiology, San Camillo Hospital, Rome, Italy
| | - Luisa De Gennaro
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Cardiology Department, San Paolo Hospital, Bari, Italy
| | - Giuseppe Leonardi
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; SSD Severe Heart Failure, PO "G. Rodolico", Catania, Italy
| | - Francesco Orso
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Heart Failure Unit, Division of Geriatric Medicine and Intensive Care Unit, Department of Medicine and Geriatrics, Careggi University Hospital, Florence, Italy
| | - Anna Rita Felici
- UOC di Cardiologia e UTIC, Ospedale dei Castelli, Ariccia, Italy
| | | | - Marina Floresta
- UOC Cardiologia e UTIC Villa Sofia, AOR Villa Sofia-Cervello, Palermo, Italy
| | - Vittoria Rizzello
- UOC Cardiologia d'urgenza e UTIC, AO San Giovanni Addolorata, Roma, Italy
| | - Donata Lucci
- ANMCO Research Centre, Heart Care Foundation, Florence, Italy
| | - Lucio Gonzini
- ANMCO Research Centre, Heart Care Foundation, Florence, Italy
| | - Renata De Maria
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy.
| | - Marco Marini
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Department of Cardiovascular Sciences Cardiology, Ospedali Riuniti, Ancona, Italy
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Clephas PRD, Malgie J, Schaap J, Koudstaal S, Emans M, Linssen GCM, de Boer GA, van Heerebeek L, Borleffs CJW, Manintveld OC, van Empel V, van Wijk S, van den Heuvel M, da Fonseca C, Damman K, van Ramshorst J, van Kimmenade R, van de Ven ART, Tio RA, van Veghel D, Asselbergs FW, de Boer RA, van der Meer P, Greene SJ, Brunner‐La Rocca H, Brugts JJ. Guideline implementation, drug sequencing, and quality of care in heart failure: design and rationale of TITRATE-HF. ESC Heart Fail 2024; 11:550-559. [PMID: 38064176 PMCID: PMC10804201 DOI: 10.1002/ehf2.14604] [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: 05/01/2023] [Revised: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/03/2024] Open
Abstract
AIMS Current heart failure (HF) guidelines recommend to prescribe four drug classes in patients with HF with reduced ejection fraction (HFrEF). A clear challenge exists to adequately implement guideline-directed medical therapy (GDMT) regarding the sequencing of drugs and timely reaching target dose. It is largely unknown how the paradigm shift from a serial and sequential approach for drug therapy to early parallel application of the four drug classes will be executed in daily clinical practice, as well as the reason clinicians may not adhere to new guidelines. We present the design and rationale for the real-world TITRATE-HF study, which aims to assess sequencing strategies for GDMT initiation, dose titration patterns (order and speed), intolerance for GDMT, barriers for implementation, and long-term outcomes in patients with de novo, chronic, and worsening HF. METHODS AND RESULTS A total of 4000 patients with HFrEF, HF with mildly reduced ejection fraction, and HF with improved ejection fraction will be enrolled in >40 Dutch centres with a follow-up of at least 3 years. Data collection will include demographics, physical examination and vital parameters, electrocardiogram, laboratory measurements, echocardiogram, medication, and quality of life. Detailed information on titration steps will be collected for the four GDMT drug classes. Information will include date, primary reason for change, and potential intolerances. The primary clinical endpoints are HF-related hospitalizations, HF-related urgent visits with a need for intravenous diuretics, all-cause mortality, and cardiovascular mortality. CONCLUSIONS TITRATE-HF is a real-world multicentre longitudinal registry that will provide unique information on contemporary GDMT implementation, sequencing strategies (order and speed), and prognosis in de novo, worsening, and chronic HF patients.
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Affiliation(s)
- Pascal R. D. Clephas
- Department of CardiologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Jishnu Malgie
- Department of CardiologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Jeroen Schaap
- Department of CardiologyAmphia ZiekenhuisBredaThe Netherlands
| | - Stefan Koudstaal
- Department of CardiologyGroene Hart ZiekenhuisGoudaThe Netherlands
| | - Mireille Emans
- Department of CardiologyIkazia ZiekenhuisRotterdamThe Netherlands
| | | | | | | | | | - Olivier C. Manintveld
- Department of CardiologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Vanessa van Empel
- Department of CardiologyMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Sandra van Wijk
- Department of CardiologyZuyderland HospitalSittardThe Netherlands
| | | | - Carlos da Fonseca
- Department of CardiologyMedisch Centrum LeeuwardenLeeuwardenThe Netherlands
| | - Kevin Damman
- Department of CardiologyUniversity Medical Centre Groningen, University of GroningenGroningenThe Netherlands
| | - Jan van Ramshorst
- Department of CardiologyNoordwest Hospital GroupAlkmaarThe Netherlands
| | - Roland van Kimmenade
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - René A. Tio
- Department of CardiologyCatharina HospitalEindhovenThe Netherlands
| | | | | | - Rudolf A. de Boer
- Department of CardiologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Peter van der Meer
- Department of CardiologyUniversity Medical Centre Groningen, University of GroningenGroningenThe Netherlands
| | - Stephen J. Greene
- Duke Clinical Research InstituteDurhamNCUSA
- Division of CardiologyDuke University School of MedicineDurhamNCUSA
| | | | - Jasper J. Brugts
- Department of CardiologyErasmus MC University Medical CenterRotterdamThe Netherlands
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