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A. Basics
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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In-hospital management of disease modifying drugs in heart failure with reduced ejection fraction - an opportunity to improve?
Session:
Posters 5 - Écran 6 - Insuficiência Cardíaca
Speaker:
Inês Lousa Manso Meirinho Nabais
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Inês Nabais; Inês Lopes da Costa; Inês Egídio de Sousa; Francisco Adragão; Patrícia Moniz; Luis Campos; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Introduction</strong>: Heart failure (HF) is a syndrome with high morbimortality and its prevalence continues to grow. New therapeutic options are an opportunity to change the natural history of the disease. Guidelines recommend in-hospital maintenance or initiation of all disease-modifying drugs (DMD), with titration as much as possible before discharge.</p> <p><strong>Objective</strong>: To analyse in-hospital management of DMD in HF with reduced ejection fraction (HFrEF) patients admitted in an Acute Heart Failure Unit (AHFU).</p> <p><strong>Methods</strong>: Retrospective study of consecutive hospitalizations due to acutely decompensated HF, over one year, examining hospital databases. HFrEF patients discharged from the AHFU were selected to evaluate medication at admission, in-hospital and at discharge.</p> <p><strong>Results: </strong>From the 181 AHFU admitted patients, 76 HFrEF were included. At admission 68.4% were on renin-angiotensine-aldosterone inhibitor (RASi) - 50.0% ACEi, 9.2% ARB, 9.2% ARNI; 72.4% on beta blocker (BB) and 65.8% on mineralocorticoid receptor antagonists (MRA). At discharge 77.6% were on RASi - 57.9% ACEi; 9.2% ARB; 10.5% ARNI -; 85.5% on BB and 77.6% on MRA; 57.9% were on triple DMD therapy and 10.5% on Ivabradine. Regarding ACEi: 34.1% started, 18.2% increased and 27.3% maintained ambulatory dose; Regarding ARB: 14.3% started, 14.3% increased and 42.9% maintained ambulatory dose. Regarding ARNI: 25% started, 23.5% increased and 50% maintained ambulatory dose. Although during hospitalization all DMD were titrated to patients maximum tolerated dose, at discharge most patients on RASi (83.1%) and BB (80.0%) were not on maximum doses according to guidelines, while on MRA only few patients (27.1%) didn’t reach maximum doses. Very few patients needed to reduce or suspend DMD medication at admission - 5.8% reduced and 21.2% suspended RASi, mainly due to low blood pressure (50.0%) and renal disease (30.0%); 12.7% reduced and 10.9% suspended BB mainly due to low blood pressure (38.9%) and bradycardia (22.2%); 6% both reduced and suspended MRA mainly due to renal disease (60.0%).</p> <p><strong>Conclusion</strong>: While being a predictor of bad prognosis, hospitalization was an opportunity to optimize HFrEF treatment. At discharge patients’ DMDs maximum tolerated doses, were frequently inferior to guideline’s recommended maximum dosages. Although in line with other real-life registries and even trials, titration should always be re-challenged in an early post-discharge assessment.</p>
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