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Guideline-Directed Medical Therapy Tolerability in Patients With Heart Failure and Mitral Regurgitation: The COAPT

Zachary L Cox1, Sandip K Zalawadiya2, Matheus Simonato3

  • 1Lipscomb University College of Pharmacy, Nashville, Tennessee, USA; Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

JACC. Heart Failure
|April 28, 2023
PubMed

Insights

In heart failure patients, most tolerated guideline-directed medical therapies (GDMT) but had intolerances preventing goal doses. This highlights challenges in optimizing GDMT for severe mitral regurgitation.

Area of Science:

  • Cardiology
  • Heart Failure Management
  • Clinical Trials

Background:

  • The COAPT trial enrolled heart failure patients with functional mitral regurgitation.
  • Guideline-directed medical therapies (GDMT) were optimized by heart failure specialists before enrollment.

Purpose of the Study:

  • To assess rates, reasons, and predictors of GDMT intolerance in the COAPT trial.
  • To understand challenges in achieving optimal medical therapy for heart failure patients.

Main Methods:

  • Analyzed baseline medication use, dose, and intolerances of key heart failure drugs.
  • Included patients with left ventricular ejection fraction (LVEF) ≤40% requiring maximally tolerated doses.
  • Focused on ACEIs, ARBs, ARNIs, beta-blockers, and MRAs.

Main Results:

  • Most patients (80.2%) tolerated at least two GDMT classes.
  • Beta-blockers were most tolerated (93.1%), followed by ACEIs/ARBs/ARNIs (68.5%), and MRAs (55.0%).
  • Hypotension and kidney dysfunction were common intolerances; goal doses were rarely achieved for beta-blockers and ACEIs/ARBs/ARNIs.

Conclusions:

  • Despite specialist optimization, most heart failure patients in COAPT experienced intolerances limiting GDMT.
  • Achieving goal doses for multiple GDMT classes was uncommon.
  • Findings offer insights for implementing GDMT optimization in future trials.
Abstract

Keywords:
COAPT trialguideline-directed medical therapyheart failureintolerancemitral regurgitation

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