Tolerability and Adverse Effects in a Specialized Heart Failure Guideline-Directed Medical Therapy Optimization...

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Guideline-directed medical therapy (GDMT) for heart failure (HF) is often underutilized at target doses.
• Adverse effects (AEs), physiological factors, and therapeutic inertia contribute to suboptimal GDMT.
• This study investigated tolerability and titration-limiting AEs in a specialized HF optimization program.

Purpose of the Study:

• To explore the tolerability of GDMT in HF patients.
• To identify common AEs that limit GDMT titration to target doses.
• To analyze patient characteristics associated with suboptimal GDMT dosing.

Main Methods:

• Retrospective analysis of 254 patients completing a specialized HF optimization program.
• Assessment of baseline characteristics of patients achieving target GDMT doses.
• Analysis of the frequency and severity of four common GDMT-related AEs: hypotension, bradycardia, hyperkalemia, and renal dysfunction.

Main Results:

• Patients achieving target doses were younger, more likely to have nonischemic HF, and less likely to have recent HF hospitalizations or coronary artery disease.
• Suboptimal beta-blocker dosing was associated with older age, atrial fibrillation, and absence of hypertension.
• Suboptimal ACEI/ARB/ARNI dosing was associated with atrial fibrillation.
• 59.1% of patients experienced at least one AE that hindered GDMT titration.

Conclusions:

• GDMT optimization in specialized HF programs is complex.
• Standardized definitions for GDMT-related AEs are needed.
• Effective management strategies for AEs are crucial for improving GDMT titration.