Proportion of patients with heart failure in a specialized clinic eligible for novel therapies

Víctor Rossel; Manuel Duarte; Pilar Muñoz; Catherine Bravo; Gustavo Bobadilla; Fernando Verdugo; Carmen Guardamagna

Keywords: drug therapy, heart failure, heart diseases, Ivabradine

Abstract

Background: Pharmacological treatment improves survival in patients with heart failure with reduced ejection fraction. The use of sacubutril/valsartan and ivabradine has been recently approved and incorporated in the latest guidelines. Aim: To identify candidates eligible for these therapies among patients treated in a heart failure clinic, considering the inclusion criteria for the PARADIGM-HF and SHIFT trials. Material and Methods: Cross-sectional study on 158 patients aged 62 +/- 11 years (67% male) with heart failure and reduced ejection fraction, with at least three months of follow-up and without decompensation. The percentage of patients complying for the inclusion criteria for the PARADIGM-HF y SHIFT trials was determined. Results: In 37%, the etiology of heart failure was ischemic, 49% were in functional class I, their ejection fraction was 33 +/- 11% and their median Pro-brain natriuretic peptide was 800 pg/mL. Ninety five percent were treated with vasodilators, 97% with beta-blockers and 82% with aldosterone antagonists. Using PARADIGM-HF and SHIFT criteria, 11 patients (7%) were eligible for sacubitril / valsartan and 21 patients (13.3%) for ivabradine. Among the main causes of non-eligibility for sacubitril / valsartan were being functional class I (48.7%) and not achieving a stable dose of enalapril >= 20 mg / day or losartan >= 100 mg / day (24.7%). In the case of ivabradine, apart from those in functional class I, the absence of sinus rhythm and a heart rate < 70 / min when receiving a maximal tolerated dose of beta-blockers, were present in 22%. Conclusions: A low percentage of our patients were eligible for these therapies. Among the causes that explain these results were clinical stability, a high percentage of patients in functional class I and being in a disease modifying treatment.

Más información

Título según WOS: Proportion of patients with heart failure in a specialized clinic eligible for novel therapies
Título según SCOPUS: Proportion of patients with heart failure in a specialized clinic eligible for novel therapies [Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado]
Título según SCIELO: Pacientes elegibles para las nuevas terapias de la insuficiencia card�aca en un policl�nico especializado
Título de la Revista: REVISTA MEDICA DE CHILE
Volumen: 147
Número: 3
Editorial: SOC MEDICA SANTIAGO
Fecha de publicación: 2019
Página de inicio: 330
Página final: 333
Idioma: Spanish
DOI:

10.4067/S0034-98872019000300330

Notas: ISI, SCIELO, SCOPUS