Accelerated and personalized therapy for heart failure with reduced ejection fraction
Li Shen1,2, Pardeep Singh Jhund2, Kieran Francis Docherty2
1Department of Internal Medicine, School of Clinical Medicine, Hangzhou Normal University, Hangzhou 311121, China.
European Heart Journal
|April 25, 2022
Summary
Accelerating treatment up-titration and optimizing drug sequencing in heart failure with reduced ejection fraction (HFrEF) may prevent deaths and hospitalizations. Standard guidelines may not be optimal for HFrEF patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Current guidelines for heart failure with reduced ejection fraction (HFrEF) recommend sequential therapy initiation based on historical trial timelines.
- The optimal timing and sequence for initiating HFrEF therapies remain subjects of ongoing investigation.
Purpose of the Study:
- To model the potential benefits of accelerated up-titration and alternative sequencing of HFrEF therapies.
- To compare outcomes of conventional versus optimized treatment initiation strategies.
Main Methods:
- Utilized data from six pivotal HFrEF trials to simulate different treatment initiation strategies.
- Modeled rapid up-titration and optimized alternative sequences, including sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists.
Main Results:
- Rapid up-titration reduced composite events (HFrEF hospitalization or cardiovascular death) by 23 per 1000 patients and all-cause deaths by seven per 1000 within 12 months.
- Optimized sequencing further reduced composite outcomes by 24 per 1000 and deaths by six per 1000 at 12 months.
- The optimal sequences prioritized sodium-glucose cotransporter 2 inhibition and mineralocorticoid receptor antagonist initiation.
Conclusions:
- Accelerated up-titration and optimized sequencing of HFrEF therapies show potential to significantly improve patient outcomes.
- Modeling suggests substantial reductions in mortality and hospitalizations compared to standard treatment approaches.
- Further clinical trials are warranted to validate these findings in practice.
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