Protocol-driven approach to guideline-directed medical therapy optimization for heart failure: A real-world application to recovery.
| Autor: | Yan CL; Divison of Internal Medicine, University of Miami Health System, Miami, FL, USA., Snipelisky D; Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA., Velez M; Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA., Baran D; Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA., Estep JD; Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA., Bauerlein EJ; Miami Transplant Institute, Jackson Health System, Miami, FL, USA., Thakkar Rivera N; Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA. |
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| Jazyk: | angličtina |
| Zdroj: | American heart journal plus : cardiology research and practice [Am Heart J Plus] 2024 Aug 03; Vol. 45, pp. 100438. Date of Electronic Publication: 2024 Aug 03 (Print Publication: 2024). |
| DOI: | 10.1016/j.ahjo.2024.100438 |
| Abstrakt: | The objective of our study was to evaluate the real-world effects of an aggressive, personalized protocol for guideline-directed medical therapy (GDMT) titration in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We conducted a two-center retrospective cohort study. Patients with HFrEF who presented to a HF clinic from January 2020 to December 2022 were placed on a GDMT protocol. 180 patients were included in the study. Mean GDMT score significantly increased from 4.7 to 5.9 ( p < 0.001) between initial and final visits. Mean left ventricular ejection fraction (LVEF) significantly increased from 28 % to 33 % (+5 %, p < 0.001). 27 (15.7 %) of the 172 patients with complete New York Heart Association (NYHA) classification data had improvement by at least 1 class, while 2 (1.2 %) patients had worsening NYHA classification. 140 (77.8 %) patients had no unplanned hospitalizations between visits. 21 (11.7 %) patients had an unplanned hospitalization for acute HF during the study period with a mean time from first clinic visit to hospitalization of 183 days (range: 13-821 days). 2 (1.1 %) patients were hospitalized due to GDMT-associated adverse drug events (i.e. hypotension, hyperkalemia). 7 (3.9 %) patients died during the study period, which was lower than the predicted 1-year death rate for our cohort (12.3 %) using the MAGGIC score. In conclusion, an aggressive, personalized protocol for GDMT titration in patients with HFrEF led to significant improvements in LVEF, NYHA classification, hospitalization, and mortality in a real-world setting. This protocol may help serve as a road map to lessen the gap between clinical knowledge and practice surrounding optimization of GDMT and move HFrEF patients toward a path to recovery. Competing Interests: The authors have no conflicts of interest. (© 2024 The Authors.) |
| Databáze: | MEDLINE |
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