Most patients admitted for acute HF qualify for guideline-directed quadruple therapy
The majority of patients admitted for acute HF are eligible for foundational quadruple therapy and other medications, researchers reported in JACC: Heart Failure.
Guidelines indicate that optimal medical therapy for patients with HF includes four classes of drugs: SGLT2 inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs) and renin-angiotensin-aldosterone system inhibitors such as angiotensin receptor/neprilysin inhibitors (ARNIs), ACE inhibitors and angiotensin receptor blockers, according to the study background.
Data were derived from Moghaddam N, et al. JACC Heart Fail. 2023;doi:10.1016/j.jchf.2022.10.013.
As Healio previously reported, the guideline recommendations were borne out by the results of the STRONG-HF trial, in which an intensive treatment strategy of rapid uptitration of appropriate guideline-directed medications and close follow-up reduced death and readmission at 180 days compared with usual care in patients with acute HF.
For the present study, the researchers analyzed to what extent a cohort of patients hospitalized for acute HF between January 2017 and April 2020 included in the CAN-HF registry was eligible for guideline-directed medical therapy and newer HF agents.
The cohort included 809 patients, of whom 455 had HF with reduced ejection fraction (40% or less; mean age, 72 years; 70% men) and the remainder had HF with preserved ejection fraction (more than 40%; mean age, 79 years; 42% men), and of whom 284 had de novo HF and the remainder had chronic HF.
Among patients with HFrEF, 73.6% were eligible for ARNIs, 94.9% were eligible for beta-blockers, 84.4% were eligible for MRAs and 81.1% were eligible for SGLT2 inhibitors, Nima Moghaddam, MD, who was a cardiology fellow at the University of British Columbia, Vancouver, at the time of the study and is now an advanced heart failure and transplant cardiology fellow at Duke University Health System, and colleagues wrote.
In addition, 15.6% of patients with HFrEF were eligible for ivabradine (Corlanor, Amgen), 25.9% met trial criteria for vericiguat (Verquvo, Merck) and 30.1% met trial criteria for omecamtiv mecarbil (Cytokinetics), they wrote.
Among the HFrEF cohort, 71.6% of patients were eligible for optimal quadruple medical therapy, including 75.5% of those with de novo HF and 69.5% of those with chronic HF, the researchers wrote.
In patients with HFpEF, 37.6% met trial criteria for ARNIs and 59.9% met trial criteria for SGLT2 inhibitors, according to the researchers, who wrote that among those meeting trial criteria for ARNIs, 61.7% were women and 66.2% had EF of 57% or less, two subgroups shown to benefit from sacubitril/valsartan (Entresto, Novartis) in the PARAGON-HF trial.
In addition, 83.1% of patients with HFpEF qualified for an MRA based on criteria for the TOPCAT trial of spironolactone, 38.1% were eligible for an ACE inhibitor or angiotensin receptor blocker, Moghaddam and colleagues wrote.
Among the eligible patients with HFrEF, 19% did not receive a beta-blocker, 37.9% did not receive an ACE inhibitor or angiotensin receptor blocker, 93.4% did not receive an ARNI and 56% did not receive an MRA, the researchers wrote.
“Our hope is that by presenting these data from a contemporary acute HF population, we can set a framework for clinicians to consider early and rapid prescription of comprehensive HF therapies,” Moghaddam and colleagues wrote. “Every attempt should be made to initiate guideline-directed medical therapy in all eligible patients before discharge, because not prescribing or a delay in prescription exposes patients with HF to a clinically significant excess risk of death and readmission.”
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