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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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11. Acute Heart Failure
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15. Valvular Heart Disease
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Limiting factors for achieving maximum dose therapy in Heart Failure with reduced Ejection Fraction
Session:
Painel 1 - Insuficiência Cardíaca 7
Speaker:
Isabel Cruz
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Isabel Martins Da Cruz; Ana Leal Neto; Inês Pereira Oliveira; Daniel Seabra De Carvalho; Rui Pontes dos Santos; Aurora Andrade; Paula Pinto
Abstract
<p><strong>Introduction:</strong> Neurohormonal antagonist therapy (NHA) is crucial in the management of heart failure with reduced ejection fraction (HFrEF). One ongoing challenge is to ensure that proven heart failure therapies are used at tolerated target doses. This is mainly limited due to side effects as hyperkalemia, non-cardiac organ dysfunction and symptoms. New therapeutic options to treat hyperkalemia could be an attractive therapeutic complement in the management of some of these pts.</p> <p><strong>Purpose:</strong> Evaluate patients (pts) with HFrEF concerning NHA therapy in order to identify the main reasons for suboptimal dosage use. </p> <p><strong>Methods:</strong> Unicentric, retrospective analysis of pts followed in a HFC since 3/2011 until 11/2019. Included pts with HFrEF (ejection fraction <40%). Pts were evaluated regarding NHA therapy (Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB), Angiotensin Receptor-Neprilysin inhibitors (ARNi) and Mineralocorticoid Receptor Antagonists (MRA)). Reasons for underdosage were examined. </p> <p><strong>Results: </strong>A total of 345 pts were included (77.4% male, mean age 60.5±12.8 years). 263 pts (76%) had suboptimal dosage of NHA; major reasons for underdosing/no-prescription were hyperkalemia (38.8%), hypotension (20.2%) and worsening renal function (WRF) (14.4%). Only 1.9% had both WRF and associated hyperkalemia as reason. Regarding each therapeutic option individually: ACEi underdosage was due to hiperkalemia in 31.1%, hypotension in 29.5%, WRF in 24.2%. 5.3% had both WRF and associated hiperkalemia as reason. Concerning ARNi, the main reasons were: hypotension (22.7%), WRF (7.6%) and hiperkalemia (7.6%). As for MRAs, hiperkalemia was the reason for underdosing in 41.1%, followed by hypotension (10.1%) and WRF (9.3%). WRF and associated hiperkalemia was present in 8.9%. Chronic kidney disease (CKD) was present in 31.3% pts. No significant association was found between hiperkalemia and CKD, all-cause or cardiovascular mortality and HF hospitalizations.</p> <p><strong>Conclusion: </strong>A significant number of pts did not have optimal dosage of HF medication. Hiperkalemia was the most common limiting factor in ACEi and MRA prescription/uptitration. ARNi target-dose attainment was more frequently conditioned by hypotension. Although CKD is a well known common comorbidity in HF that may limit medication updosage, hiperkalemia was not related to WRF in most pts and had no correlation with CKD. </p>
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