Related Experiment Video

Updated: Feb 13, 2026

Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach
07:49

Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach

Published on: July 21, 2023

2.0K

Assessing Guideline-Directed Medication Therapy for Heart Failure in End-Stage Renal Disease

B Tate Cutshall1, Benjamin T Duhart2, Jagannath Saikumar3

  • 1The University of Alabama at Birmingham Medical Center, Birmingham, AL.

The American Journal of the Medical Sciences
|March 19, 2018
PubMed

Insights

Guideline-directed medication therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) did not significantly alter outcomes in end-stage renal disease (ESRD) patients. However, GDMT was associated with less hypotension, suggesting potential benefits for this population.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Pharmacology

Background:

  • Guideline-directed medication therapy (GDMT) is crucial for heart failure with reduced ejection fraction (HFrEF).
  • Concerns exist regarding underprescription of GDMT in end-stage renal disease (ESRD) patients.
  • This study investigates GDMT's impact on HFrEF patients with ESRD.

Purpose of the Study:

  • To compare outcomes for ESRD patients with HFrEF receiving GDMT versus those not receiving it.
  • To evaluate the effect of GDMT on length of stay, mortality, and readmissions in this cohort.
  • To assess the incidence of adverse events like hyperkalemia, hypotension, and bradycardia with GDMT use.

Main Methods:

  • Retrospective analysis of adult ESRD and HFrEF patients admitted over two years.
  • Categorization into GDMT and non-GDMT groups based on home medication regimens.
  • Comparison of length of stay, mortality, 30-day readmissions, and adverse events between groups.

Main Results:

  • A total of 109 patients were included; 25 received GDMT and 84 did not.
  • No significant differences in length of stay, 30-day readmissions, or in-hospital mortality between groups.
  • Hypotension occurred significantly less frequently in the GDMT group (4% vs. 27%, P = 0.01).

Conclusions:

  • GDMT did not significantly impact primary outcomes (LOS, mortality, readmissions) in ESRD patients with HFrEF.
  • The reduced incidence of hypotension in the GDMT group may hold clinical significance.
  • A substantial proportion of ESRD patients with HFrEF are not receiving GDMT, warranting further investigation.
Abstract

Keywords:
End-stage renal diseaseGuideline-directed medication therapyHeart failureHeart failure reduced ejection fractionRenin-angiotensin-aldosterone system blockers

More Related Videos

Direct Drug Delivery to Kidney via the Renal Artery11:18

Direct Drug Delivery to Kidney via the Renal Artery

Published on: April 17, 2021

8.3K
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

11.0K

Related Concept Videos

Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
360
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
395
Rheumatic Heart Disease III: Medical Management01:21

Rheumatic Heart Disease III: Medical Management

Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
380
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
493
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
1.0K
Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
4.0K