SPC365

Quadruple therapy at discharge: Enhancing clinical trajectories in decompensated heart failure with reduced ejection fraction

Session: Sessão de Posters 37 - Insuficiência cardíaca - Terapêutica farmacológica
Speaker: João Mendes Cravo

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: João Mendes Cravo; Ana Beatriz Garcia; Ana Margarida Martins; Ana Francês; Fátima Salazar; Nuno Lousada; Joana Rigueira; Rafael Santos; Doroteia Silva; F.J.Pinto; Dulce Brito; João Agostinho
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Guidelines recommend the use of multiple drugs in patients with heart failure and&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">reduced ejection fraction (HFrEF). However, there is limited real-world data on the&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">impact of simultaneously initiating the four pharmacological pillars (FPP) at&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">discharge following a decompensation event.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">A retrospective single-center study was conducted on patients with HFrEF&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">discharged after a decompensation event and followed in an HF-specialized&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">outpatient clinic from a tertiary hospital. Outcomes were compared between patients&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">discharged with FPP and those missing at least one of the FPP. Kaplan-Meier&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">survival analysis was performed.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">A total of 84 patients were included. Twenty-two patients were female (26%), with a&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">mean age of 62 years-old and the majority were ischemic (58.3%). At discharge 63%&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">of the patients had started the FPP. Patients discharged with FPP had a worse&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">mean left ventricle ejection fraction (LVEF) than those missing at least one FPP (25.7% vs 32.6%). The&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">two groups showed similarity in baseline NYHA class, NT-proBNP and eGFR, sex and&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">age. Despite not statistically significant, patients in FPP group reached maximum&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">tolerated doses of guideline-based therapies earlier (median up-titration visits of 2.1&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">vs 3.8 in FPP lacking group), reached higher doses of FPP (table 1) and had a&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">significantly greater improvement in LVEF of +14% vs +6% (mean difference of +6.86%, 95% CI: 3.26-10.46; p=0.007). In a time to event analysis considering a composite of all-cause mortality and HF-related hospitalizations with a 3-year follow-up, there was a tendency towards reduction in events in the FPP group. Despite being globally low, the 3-year event rate was 3.8 times higher in the group missing FPP (3.92 vs 14.8%).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion:&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Quadruple therapy at discharge in patients with HFrEF following a decompensation&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">event resulted in earlier and more effective guideline-based optimal medical therapy&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">uptitration, a greater improvement of LVEF after three months and a tendency&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">towards reduction in all-cause mortality and HF-related hospitalizations.</span></span></span></p>

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