From Emergency Department to clinic center: management of patients with Heart Failure with Reduced Ejection Fraction
https://doi.org/10.4081/wpph.2024.9883
Accepted: 6 December 2023
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Aims: primary outcomes - cardiovascular and all-cause mortality evaluation within 1 year in elderly patients enrolled with Angiotensin Receptor Inhibitor (ARNI) and/or Sodium Glucose Co-Transporter Type 2 Inhibitors (SGLT2-i) in an Internal Medicine Department; recurrent hospitalization assessment for acute Heart Failure with Reduced Ejection Fraction (HFrEF); length of hospitalization analysis compared to not-enrolled patients. Secondary endpoints - to identify any parameters predicting the length of hospitalization; safety assessment through the incidence of complications and treatment interruption. Materials and Methods: prospective observational real-life cohort study that analyzes the recruitment during hospitalization and follow-up 3-6-12 months after discharge. Several clinical parameters were recorded for each patient of any ethnicity, considering a diagnosis of acute HFrEF with NT-proBNP and chest x-ray. Results: the enrolled group (34 patients) showed a hospitalization period lower than the not-enrolled one. The rehospitalizations percentage was inferior to Randomized Clinical Trials (RCTs) for ARNI. Cardiovascular-cause mortality, symptomatic hypotension, and Urinary Tract Infections (UTI) were lower than RCTs data. Age, eGFR, NT-proBNP, Cumulative Illness Rating Scale (CIRS), and severe comorbidities, except for EF, predicted the lengthening of hospitalization. Hypoglycemia wasn’t recorded. Conclusions: ARNI/SGLT2-i are effective and safe in elderly patients. Comorbidities and bio-humoral features influence HFrEF and quality of life. The future aim is to confirm the results obtained so far.
McMurray JJV, Packer M. How should we sequence the treatments for HFrEF? Circulation AHA. 2021;143:875-7. DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.052926
Visseren FLJ, Mach F. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. EHJ. 2021;42:3227-37. DOI: https://doi.org/10.1093/eurheartj/ehab484
Zannad F, Ferreira JP, Pocock SJ. SGLT2 inhibitors in patients with HFrEF: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. 2020;396:819-29. DOI: https://doi.org/10.1016/S0140-6736(20)31824-9
Shen L, McMurray J, Packer M. Accelerated and personalized therapy for HFrEF. EHJ. 2022;14;43:2573-87. DOI: https://doi.org/10.1093/eurheartj/ehac210
Sinagra G, Pagura L, Stolfo D. Combining new classes of drugs for HFrEF: from trials to clinical practice. European Journal of Internal Medicine. 2021;90:10-5. DOI: https://doi.org/10.1016/j.ejim.2021.05.017
McMurray J, Packer M. Angiotensin-neprilysin inhibition versus enalapril in HF. NEJM. 2014;371;993-1004. DOI: https://doi.org/10.1056/NEJMoa1409077
Seferovic J, Claggett B. Effect of sacubitril-valsartan versus enalapril on glycaemic control in patients with HF and diabetes: a post-hoc analysis from the PARADIGM-HF trial. Lancet Diabetes Endocrinology. 2017;5:333-40. DOI: https://doi.org/10.1016/S2213-8587(17)30087-6
Sharma A, Verma S. Optimizing foundational therapies in patients with HFrEF. JACC. 2022;7:504-17. DOI: https://doi.org/10.1016/j.jacbts.2021.10.018
Longo L, Braunwald E. Gliflozins in the management of cardiovascular disease. NEJM. 2022;386:2024-34. DOI: https://doi.org/10.1056/NEJMra2115011
McMurray J, Solomon SD, Inzucchi SE. Dapagliflozin in patients with HFrEF. NEJM. 2019;381:1995-2008. DOI: https://doi.org/10.1056/NEJMoa1911303
Packer M, Anker SD, Filippatos G. Cardiovascular and renal outcomes with empagliflozin in HF. NEJM. 2020;383:1413-24. DOI: https://doi.org/10.1056/NEJMoa2022190
Goodman & Gilman’s. Pharmacological Basis of Therapeutics. 12th Ed. New York, USA; McGraw-Hill Education; 2010.
The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive HF. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). NEJM. 1987;316:1429-35. DOI: https://doi.org/10.1056/NEJM198706043162301
The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular EF and congestive HF. NEJM. 1991;325:293-302. DOI: https://doi.org/10.1056/NEJM199108013250501
Lee DS, Stukel TA, Austin PC, et al. Improved outcomes with early collaborative care of ambulatory HF patients discharged from the emergency department. Circulation. 2010;122:1806-14. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.940262
Phillips CO, Wright SM, Kern DE, et al. Comprehensive discharge planning with post-discharge support for older patients with congestive HF: a meta-analysis. JAMA. 2004;291:1358-67. DOI: https://doi.org/10.1001/jama.291.11.1358
Desai AS, Stevenson LW. Rehospitalization for HF: predict or prevent? Circulation 2012;126:501-6. DOI: https://doi.org/10.1161/CIRCULATIONAHA.112.125435
Sud M, Yu B, Wijeysundera HC, et al. Associations Between Short or Long Length of Stay and 30-Day Readmission and Mortality in Hospitalized Patients With HF. JACC Heart Fail. 2017;5:578-88. DOI: https://doi.org/10.1016/j.jchf.2017.03.012
Targher G, Dauriz M, Laroche C, et al. In-hospital and 1-year mortality associated with diabetes in patients with acute HF: results from the ESC-HFA HF Long-Term Registry. Eur. J. Heart Fail. 2017;19:54-65. DOI: https://doi.org/10.1002/ejhf.679
Mentz RJ, Fiuzat M, Wojdyla DM, et al. Clinical characteristics and outcomes of hospitalized HF patients with systolic dysfunction and chronic obstructive pulmonary disease: findings from OPTIMIZE-HF. Eur. J. Heart Fail. 2012;14:395-403. DOI: https://doi.org/10.1093/eurjhf/hfs009
Adams KF, Fonarow GC, Emerman CL, et al. Characteristics and outcomes of patients hospitalized for HF in the US: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated HF National Registry (ADHERE). AHJ. 2005;149:209-16. DOI: https://doi.org/10.1016/j.ahj.2004.08.005
Gheorghiade M, Peterson ED. Improving post-discharge outcomes in patients hospitalized for acute HF syndromes. JAMA. 2011;305:2456-7. DOI: https://doi.org/10.1001/jama.2011.836
Thavendiranathan P, Yingchoncharoen T, Grant A, et al. Prediction of 30-day HF-specific readmission risk by echocardiographic parameters. AJC. 2014;113:335-41. DOI: https://doi.org/10.1016/j.amjcard.2013.09.025
Metra M, Cotter G, Senger S, et al. Prognostic Significance of Creatinine Increases During an Acute HF Admission in Patients with and Without Residual Congestion. Circ. Heart Fail. 2018;11. DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.117.004644
Santaguida PL, Don-Wauchope AC, Oremus M, et al. BNP and NT-proBNP as prognostic markers in persons with acute decompensated HF: a systematic review. Heart Fail. Rev. 2014;19:453-70. DOI: https://doi.org/10.1007/s10741-014-9442-y
Davison BA, Metra M, Senger S, et al. Patient journey after admission for acute HF: length of stay, 30-day readmission and 90-day mortality. Eur. J. Heart Fail. 2016;18:1041-50. DOI: https://doi.org/10.1002/ejhf.540
Braunwald E. The war against HF: the Lancet lecture. Lancet. 2015;385:812-24. DOI: https://doi.org/10.1016/S0140-6736(14)61889-4
Heidenreich PA, Aguilar D, Yancy CW, et al. 2022 ACCF/AHA guideline for the management of HF: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. ACC. 2022;62:e147-239.
McDonagh Th. A, Metra M, McMurray J, et al., 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic HF. EHJ. 2021;42:3599-726. DOI: https://doi.org/10.1093/eurheartj/ehab368
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