Medicines optimization prior to discharge in patients admitted to hospital with heart failure.

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.

• Authors: Joseph J Cuthbert, Oliver I Brown, Pierpaolo Pellicori, Karen Dobbs, Jeanne Bulemfu, Syed Kazmi, Ioanna Sokoreli, Steffan C Pauws, Jarno M Riistama, John G F Cleland, Andrew L Clark
• Journal: ESC heart failure (ESC Heart Fail) Vol. 11 Issue 2 Pg. 950-961 (Apr 2024) ISSN: 2055-5822 [Electronic] England
• PMID: 38229241 (Publication Type: Journal Article)
• Copyright: © 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Tetrazoles

Topics

• Humans
• Patient Discharge
• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Tetrazoles (therapeutic use)
• Treatment Outcome
• Stroke Volume (physiology)
• Heart Failure
• Hospitals