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Real-world impact of early quadruple therapy in HFrEF: A comparative analysis of sequential vs. simultaneous approaches
Session:
Sessão de Posters 37 - Insuficiência cardíaca - Terapêutica farmacológica
Speaker:
Diogo Rosa Ferreira
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Diogo Rosa Ferreira; Catarina Gregório; Ana Beatriz Garcia; Ana Francês; Fátima Salazar; Rafael Santos; Joana Rigueira; Doroteia Silva; Nuno Lousada; Fausto Pinto; Dulce Brito; João Agostinho
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">Introduction:</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">The treatment approach for heart failure with reduced ejection fraction (HFrEF) underwent a</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">paradigm shift after the 2021 European Society of Cardiology Heart Failure Guidelines (GL).</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">Contrary to the previous sequential strategy, which was a cornerstone in HFrEF</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">management, the updated guidelines advocate for the early initiation of quadruple therapy</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">based on recent clinical trials. However, this approach lacks validation in clinical trials or</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">real-world registries.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">Purpose:</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">To assess in real-world data the impact on 3-year all-cause mortality and HF-hospitalization</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">rate of early initiation of quadruple therapy against sequential therapy initiation in HFrEF</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">patients.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">Methods:</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">A population of consecutive patients (pts) included in a HF outpatient clinic in a tertiary </span></span></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">center was analyzed. A prospective group of 150 consecutive pts who initiated follow-up </span></span></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">(FUP) from 2019-2022, embracing a baseline treatment approach involving early initiation of</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">quadruple therapy was defined as the intervention group - “2021 GL group”. The control</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">group was composed by 150 retrospective pts who commenced FUP from 2016-2020,</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">adhering to the sequential approach - “2016 GL group”.</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">The study groups were compared with Chi-square and Mann-Whitney tests. Impact on</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">outcomes was established with Kaplan-Meier survival analysis and multivariate Cox</span></span></span><span style="font-family:"Times New Roman",serif"> r</span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">egression</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">Results:</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">The 300 pts included were 65±9 years and were followed for 25±10 months. The most </span></span></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">common HF etiologies were dilated cardiomyopathy (44.2%) and ischemic heart disease </span></span></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">(42%), median LVEF was 29%.</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">Age, creatinine clearance, initial left ventricle ejection fraction and NYHA class distribution</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">were similar in both groups.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">Mean doses of each foundational therapy at FUP are displayed in Table 1.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">All-cause mortality rate during the 3-year follow-up was significantly different between the</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">two groups: 10% in the 2016 GL group and 1.3% in the 2021 GL group (p=0.006). The</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">number of HF admissions was also significantly lower in the 2021 GL group (9.3% vs 41.2%,p<0.001). Patients in the 2016 GL group had 2.6 times the risk of composite outcome of all-cause death and HF-hospitalization (HR: 2.56, CI 95%:1.49-4.42, p&lt;0.001).</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">Conclusion:</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">In this real-world analysis comparing the sequential therapy approach to the early initiation of</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">quadruple therapy in HFrEF patients, significant differences in outcomes were observed in</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">all-cause mortality and HF-hospitalizations over a 3-year follow-up period. These findings</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">underscore the safety and benefits of adopting the recommended early initiation of</span></span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">quadruple therapy in the management of HFrEF.</span></span></span></span></span></p> <p> </p>
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