Details

Autor(en) / Beteiligte

• Girerd, Nicolas
• Von Hunolstein, Jean‐Jacques
• Pellicori, Pierpaolo
• Bayés‐Genís, Antoni
• Jaarsma, Tiny
• Lund, Lars H.
• Bilbault, Pascal
• Boivin, Jean‐Marc
• Chouihed, Tahar
• Costa, Jérôme
• Eicher, Jean‐Christophe
• Fall, Estelle
• Kenizou, David
• Maillier, Bruno
• Nazeyrollas, Pierre
• Roul, Gérald
• Zannad, Noura
• Rossignol, Patrick
• Seronde, Marie‐France

Titel

Therapeutic inertia in the pharmacological management of heart failure with reduced ejection fraction

Ist Teil von

• ESC Heart Failure, 2022-08, Vol.9 (4), p.2063-2069

Ort / Verlag

England: John Wiley & Sons, Inc

Erscheinungsjahr

2022

Quelle

Wiley Online Library Journals Frontfile Complete

Beschreibungen/Notizen

• Introduction Randomized controlled trials (RCTs) have established the efficacy of several therapies to improve both symptoms and outcomes for patients with heart failure and reduced left ventricular ejection fraction (HFrEF). Compared with ACE-I, the use of ARNI decreases the risk of renal dysfunction and severe hyperkalaemia in HFrEF. 19 Adding an SGLT2 inhibitors would also prevent deterioration of kidney function and decrease the risk of hyperkalaemia. 20 The use of novel potassium binders could normalize K levels; whether this will lead to higher prescription or RAASi and better outcomes is currently under evaluation. 21,22 Hypotension Low blood pressure is a marker of more advanced disease and associates with poor prognosis but does not diminish the efficacy of HF treatments. 23 Yet low BP is a common barrier to HFrEF medication use and up-titration. 24 Even with systolic BP > 110 mmHg, a majority of patients do not receive target doses of GDMT, 25 suggesting that overemphasized fear of hypotension (or therapeutic inertia) may exist. A pharmacological management algorithm, based on a comprehensive review of available evidence aimed at helping physicians treat HFrEF patients with low BP, has been recently proposed. 24 Reducing diuretic dose or stopping unnecessary medications (i.e. calcium-antagonists) should be considered to improve their management in this situation. 24 Difficulties related to health care systems Limited access to HF expertise is a major driver of both therapeutic inertia and poor implementation more generally. 26,27 The number of patients with HF is increasing in Europe and USA (mostly in the context of rising number of HF with preserved ejection fraction), and current healthcare systems are not well developed to provide optimal care for everyone, fuelling inertia. Many patients with HFrEF do not receive cardiology input whilst in hospital, and many others are not followed-up early after discharge or are only managed by primary care physicians. 26 Disease management programmes remain underdeveloped and/or inadequately implemented, even though they offer specialized follow-up, improve HF prognosis, and are cost-saving. 28 Finally, aside from healthcare systems, awareness of HF burden is limited in the general population and underrepresented in the media.