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Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
Published on: June 30, 2023
[Proportion of patients with heart failure in a specialized clinic eligible for novel therapies]
Víctor Rossel1, Manuel Duarte2, Pilar Muñoz1
1Sección Cardiología, Servicio de Medicina Interna, Hospital del Salvador, Santiago, Chile.
Insights
Few heart failure patients met eligibility for sacubitril/valsartan and ivabradine. Many patients were functional class I or on optimal medical therapy, excluding them from these advanced heart failure treatments.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Pharmacological treatments significantly improve survival in patients diagnosed with heart failure with reduced ejection fraction (HFrEF).
- Sacubitril/valsartan and ivabradine are recently approved therapies for HFrEF, now included in major clinical guidelines.
- Optimizing medical therapy is crucial for managing HFrEF and improving patient outcomes.
Purpose of the Study:
- To determine the proportion of patients in a heart failure clinic eligible for sacubitril/valsartan and ivabradine.
- To assess eligibility based on the inclusion criteria of landmark trials PARADIGM-HF and SHIFT.
- To identify barriers to treatment initiation for these advanced HFrEF therapies.
Main Methods:
- A cross-sectional study was conducted on 158 HFrEF patients with a minimum three-month follow-up and no recent decompensation.
- Patient data were analyzed to evaluate compliance with the inclusion criteria for the PARADIGM-HF and SHIFT trials.
- Eligibility percentages for sacubitril/valsartan and ivabradine were calculated.
Main Results:
- Only 7% of patients (11/158) were eligible for sacubitril/valsartan and 13.3% (21/158) for ivabradine.
- Key reasons for non-eligibility for sacubitril/valsartan included being in functional class I (48.7%) and not achieving target doses of enalapril or losartan (24.7%).
- For ivabradine, non-eligibility was attributed to absence of sinus rhythm or heart rate below 70 bpm on maximally tolerated beta-blockers in 22% of patients, in addition to functional class I.
Conclusions:
- A low percentage of heart failure patients in this clinic met eligibility criteria for sacubitril/valsartan and ivabradine.
- Clinical stability, a high prevalence of functional class I patients, and existing disease-modifying treatments contributed to low eligibility rates.
- Further research may be needed to refine treatment strategies for HFrEF patients who do not meet current trial criteria.
Background:
Pharmacological treatment improves survival in patients with heart failure with reduced ejection fraction. The use of sacubutril/valsartan and ivabradine has been recently approved and incorporated in the latest guidelines.
Aim:
To identify candidates eligible for these therapies among patients treated in a heart failure clinic, considering the inclusion criteria for the PARADIGM-HF and SHIFT trials.
Material And Methods:
Cross-sectional study on 158 patients aged 62 ± 11 years (67% male) with heart failure and reduced ejection fraction, with at least three months of follow-up and without decompensation. The percentage of patients complying for the inclusion criteria for the PARADIGM-HF y SHIFT trials was determined.
Results:
In 37%, the etiology of heart failure was ischemic, 49% were in functional class I, their ejection fraction was 33 ± 11% and their median Pro-brain natriuretic peptide was 800 pg/mL. Ninety five percent were treated with vasodilators, 97% with beta-blockers and 82% with aldosterone antagonists. Using PARADIGM-HF and SHIFT criteria, 11 patients (7%) were eligible for sacubitril / valsartan and 21 patients (13.3%) for ivabradine. Among the main causes of non-eligibility for sacubitril / valsartan were being functional class I (48.7%) and not achieving a stable dose of enalapril ≥ 20 mg / day or losartan ≥ 100 mg / day (24.7%). In the case of ivabradine, apart from those in functional class I, the absence of sinus rhythm and a heart rate < 70 / min when receiving a maximal tolerated dose of beta-blockers, were present in 22%.
Conclusions:
A low percentage of our patients were eligible for these therapies. Among the causes that explain these results were clinical stability, a high percentage of patients in functional class I and being in a disease modifying treatment.
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