SPC365

Main limiting factors of foundational therapy introduction in patients with heart failure with reduced ejection fraction

Session: Comunicações Orais (Sessão 12) - Insuficiência Cardíaca 2 - Tratamento
Speaker: Catarina Oliveira

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Catarina Simões de Oliveira; João Agostinho; Pedro Silvério António; Sara Couto Pereira; Joana Brito; Pedro Alves da Silva; Beatriz Valente Silva; Ana Beatriz Garcia; Ana Margarida Martins; Rafael Santos; Joana Rigueira; Doroteia Silva; Nuno Lousada; Fausto j. Pinto; Dulce Brito

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><strong><span style="font-family:Calibri">Introduction: </span></strong><span style="font-family:Calibri">ESC Heart failure (HF) guidelines recommend the introduction of 4 different pharmacological classes &ndash; foundation therapy (FT) &ndash; in all patients (pts) with HFrEF as all these classes have a significant impact in mortality and HF hospitalizations. However, due to these drugs side effects and the complexity of HFrEF pts, pharmacologic initiation and uptitration may become a challenge. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><strong><span style="font-family:Calibri">Purpouse: </span></strong><span style="font-family:Calibri">&nbsp;To identify the main limiting factors that conducted to non-initiation of foundational therapy in a cohort of pts with HFrEF.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><strong><span style="font-family:Calibri">Methods: </span></strong><span style="font-family:Calibri">Retrospective single-center study of HFrEF pts followed in a multidisciplinary HF unit. Clinical characteristics and pharmacological therapy data, mainly the reasons for therapy non-initiation were collected. Statistical analysis was performed using Chi-square and Mann-Whitney tests and the impact of the main FT initiation limiting factors was assessed using Cox regression and Kaplan-Meier survival analysis.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><strong><span style="font-family:Calibri">Results: </span></strong><span style="font-family:Calibri">A total of 275 pts (mean age: 66&plusmn;14 years; 70.7% males) were included. Ischemic heart disease (45.7%) and dilated cardiomyopathy (41.7%) were the main HFrEF etiologies. At follow-up 58.3% patients were at NYHA functional class II and 7.2% at III. The mean left ventricular ejection fraction (LVEF) was 36&plusmn;12%, NT-proBNP, 3385&plusmn;8701 pg/mL, eGFR, 61&plusmn;27 and potassium, 4.7&plusmn;0.58 mmol/L. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="font-family:Calibri">At the end of follow-up, a reason that inhibited therapy initiating was present in 148 (54%) pts and 127 (46%) were treated with all the 4 FT classes; </span><span style="font-family:Calibri"><span style="color:black">271 (</span></span><span style="font-family:Calibri">98.2%) pts were treated with a B-blocker, </span><span style="font-family:Calibri"><span style="color:black">178 (64.5%) with A</span></span><span style="font-family:Calibri">RNI, </span><span style="font-family:Calibri"><span style="color:black">86 (31.1%)</span></span><span style="font-family:Calibri"> with ACEi/ARB, </span><span style="font-family:Calibri"><span style="color:black">236 (85.5%) with </span></span><span style="font-family:Calibri">MRA and 176 (63.8%) with iSGLT2<sub>.</sub></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="font-family:Calibri">The highest rate of therapy non-initiation was observed in ARNI (64 pts) and the main reasons were symptomatic hypotension (22 pts) and economic insufficiency (23 pts). Most pts that did not started on MRA had prohibitive hyperkaliemia (18 pts) or worsening renal function (7 pts). Pts that were not started on SGLT2 had symptomatic hypotension (14 pts) or worsening renal function (7 pts). The most well tolerated drug were B-blockers, with a very low rate of non-initiation (10 pts) mainly because of lower heart rate &ndash; Figure 1.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="font-family:Calibri">During a mean follow-up of 1.43&plusmn;1.15 years, 33 (12%) pts died and 40 (14.5%) pts were hospitalized due to HF. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="font-family:Calibri">Globally symptomatic hypotension was the main reason of FT non-initiation. On multivariate analysis symptomatic hypotension was a predictor of HF events independently of its impact on FT initiation (HR 2.37, 95%CI 1.2-4.8; p=0.016) &ndash; Figure 1.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;"><strong><span style="font-family:Calibri">Conclusion: </span></strong><span style="font-family:Calibri">This real-world cohort showed a high rate of FT non-initiation in HFrEF pts. The main FT initiation limiting factor was symptomatic hypotension that had a significant impact on prognosis partially related with its repercussion in HFrEF medical therapy. </span></span></span></p>