Perceived risk profile and treatment optimization in heart failure: an analysis from BIOlogy Study to TAilored Treatment in chronic heart failure

TY - JOUR

T1 - Perceived risk profile and treatment optimization in heart failure

T2 - an analysis from BIOlogy Study to TAilored Treatment in chronic heart failure

AU - Kobayashi, Masatake

AU - Voors, Adriaan A.

AU - Ouwerkerk, Wouter

AU - Duarte, Kevin

AU - Girerd, Nicolas

AU - Rossignol, Patrick

AU - Metra, Marco

AU - Lang, Chim C.

AU - Ng, Leong L.

AU - Filippatos, Gerasimos

AU - Dickstein, Kenneth

AU - van Veldhuisen, Dirk J.

AU - Zannad, Faiez

AU - Ferreira, João Pedro

N1 - Funding Information: BIOSTAT‐CHF was funded by the European Commission (FP7‐242209‐BIOSTAT‐CHF). Further financial support was provided by Roche diagnostics. João Pedro Ferreira, Nicolas Girerd, Patrick Rossignol, Faiez Zannad are supported by the French National Research Agency Fighting Heart Failure (ANR‐15‐RHU‐0004), by the French PIA project “Lorraine Université d'Excellence” GEENAGE (ANR‐15‐IDEX‐04‐LUE) programmes, and the Contrat de Plan Etat Région Lorraine and FEDER IT2MP. Publisher Copyright: © 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.

PY - 2021/6

Y1 - 2021/6

N2 - Background: Achieving target doses of angiotensin-converting-enzyme inhibitor/angiotensin-receptor blockers (ACEi/ARB) and beta-blockers in heart failure with reduced ejection fraction (HFrEF) is often underperformed. In BIOlogy Study to TAilored Treatment in chronic heart failure (BIOSTAT-CHF) study, many patients were not up-titrated for which no clear reason was reported. Therefore, we hypothesized that perceived-risk profile might influence treatment optimization.Methods: We studied 2100 patients with HFrEF (LVEF≤40%) to compare the clinical characteristics and adverse events associated with treatment up-titration (after a 3-month titration protocol) between; a) patients not reaching target doses for unclear reason; b) patients not reaching target doses due to symptoms and/or side effects; c) patients reaching target doses.Results: For ACEi/ARB, (a), (b) and (c) was observed in 51.3%, 25.9% and 22.7% of patients, respectively. For beta-blockers, (a), (b) and (c) was observed in 67.5%, 20.2% and 12.3% of patients, respectively. By multinomial logistic regression analysis for ACEi/ARB, patients in group (a) and (b) had lower blood pressure and poorer renal function, and patients in group (a) were older and had lower ejection fraction. For beta-blockers, patients in group (a) and (b) had more severe congestion and lower heart rate. At 9 months, adverse events (i.e., hypotension, bradycardia, renal impairment, and hyperkalemia) occurred similarly among the three groups.Conclusions: Patients in whom clinicians did not give a reason why up-titration was missed were older and had more co-morbidities. Patients in whom up-titration was achieved did not have excess adverse events. However, from these observational findings, the pattern of subsequent adverse events among patients in whom up-titration was missed cannot be determined.

AB - Background: Achieving target doses of angiotensin-converting-enzyme inhibitor/angiotensin-receptor blockers (ACEi/ARB) and beta-blockers in heart failure with reduced ejection fraction (HFrEF) is often underperformed. In BIOlogy Study to TAilored Treatment in chronic heart failure (BIOSTAT-CHF) study, many patients were not up-titrated for which no clear reason was reported. Therefore, we hypothesized that perceived-risk profile might influence treatment optimization.Methods: We studied 2100 patients with HFrEF (LVEF≤40%) to compare the clinical characteristics and adverse events associated with treatment up-titration (after a 3-month titration protocol) between; a) patients not reaching target doses for unclear reason; b) patients not reaching target doses due to symptoms and/or side effects; c) patients reaching target doses.Results: For ACEi/ARB, (a), (b) and (c) was observed in 51.3%, 25.9% and 22.7% of patients, respectively. For beta-blockers, (a), (b) and (c) was observed in 67.5%, 20.2% and 12.3% of patients, respectively. By multinomial logistic regression analysis for ACEi/ARB, patients in group (a) and (b) had lower blood pressure and poorer renal function, and patients in group (a) were older and had lower ejection fraction. For beta-blockers, patients in group (a) and (b) had more severe congestion and lower heart rate. At 9 months, adverse events (i.e., hypotension, bradycardia, renal impairment, and hyperkalemia) occurred similarly among the three groups.Conclusions: Patients in whom clinicians did not give a reason why up-titration was missed were older and had more co-morbidities. Patients in whom up-titration was achieved did not have excess adverse events. However, from these observational findings, the pattern of subsequent adverse events among patients in whom up-titration was missed cannot be determined.

KW - ACE-inhibitor

KW - adverse effects

KW - ARB

KW - beta-blocker

KW - treatment up-titration

UR - https://www.scopus.com/pages/publications/85105667247

U2 - 10.1002/clc.23576

DO - 10.1002/clc.23576

M3 - Article

C2 - 33960439

SN - 0160-9289

VL - 44

SP - 780

EP - 788

JO - Clinical Cardiology

JF - Clinical Cardiology

IS - 6

ER -