Cuthbert, J. J. et al. (2024) Medicines optimization prior to discharge in patients admitted to hospital with heart failure. ESC Heart Failure, (doi: 10.1002/ehf2.14638) (Early Online Publication)
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Abstract
Aims: Approximately half of patients with heart failure and a reduced ejection fraction (HeFREF) are discharged from hospital on triple therapy [angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs), beta-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs)]. We investigated what proportion of patients are on optimal doses prior to discharge and how many might be eligible for initiation of sacubitril–valsartan or sodium-glucose co-transporter-2 inhibitors (SGLT2Is). Methods and results: Between 2012 and 2017, 1277 patients admitted with suspected heart failure were enrolled at a single hospital serving a local community around Kingston upon Hull, UK. Eligibility for sacubitril–valsartan or SGLT2I was based on entry criteria for the PIONEER-HF, DAPA-HF, and EMPEROR-Reduced trials. Four hundred fifty-five patients had HeFREF with complete data on renal function, heart rate, and systolic blood pressure (SBP) prior to discharge. Eighty-three per cent of patients were taking an ACE-I or ARB, 85% a BB, and 63% an MRA at discharge. More than 60% of patients were eligible for sacubitril–valsartan and >70% for SGLT2I. Among those not already receiving a prescription, 37%, 28%, and 49% were eligible to start ACE-I or ARB, BB, and MRA, respectively. Low SBP (≤105 mmHg) was the most frequent explanation for failure to initiate or up-titrate therapy. Conclusions: Most patients admitted for heart failure are eligible for initiation of life-prolonging medications prior to discharge. A hospital admission may be a common missed opportunity to improve treatment for patients with HeFREF.
| Item Type: | Articles |
|---|---|
| Keywords: | Quadruple therapy, inpatient, medicine optimization, heart failure, discharge. |
| Status: | Early Online Publication |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Cleland, Professor John and Pellicori, Dr Pierpaolo |
| Authors: | Cuthbert, J. J., Brown, O. I., Pellicori, P., Dobbs, K., Bulemfu, J., Kazmi, S., Sokoreli, I., Pauws, S. C., Riistama, J. M., Cleland, J. G.F., and Clark, A. L. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | ESC Heart Failure |
| Publisher: | Wiley |
| ISSN: | 2055-5822 |
| ISSN (Online): | 2055-5822 |
| Published Online: | 16 January 2024 |
| Copyright Holders: | Copyright © 2024 The Authors |
| First Published: | First published in ESC Heart Failure 2024 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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