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1.
Open Heart ; 10(2)2023 Nov 27.
Article in English | MEDLINE | ID: mdl-38011993

ABSTRACT

INTRODUCTION: This study aimed to evaluate the use and dose of loop diuretics (LDs) across the entire ejection fraction (EF) spectrum in a large, 'real-world' cohort of chronic heart failure (HF) patients. METHODS: A total of 10 366 patients with chronic HF from 34 Dutch outpatient HF clinics were analysed regarding diuretic use and diuretic dose. Data regarding daily diuretic dose were stratified by furosemide dose equivalent (FDE)>80 mg or ≤80 mg. Multivariable logistic regression models were used to assess the association between diuretic dose and clinical features. RESULTS: In this cohort, 8512 (82.1%) patients used diuretics, of which 8179 (96.1%) used LDs. LD use was highest among HF with reduced EF (HFrEF) patients (81.1%) followed by HF with mild-reduced EF (76.1%) and HF with preserved ejection fraction EF (73.8%, p<0.001). Among all LDs users, the median FDE was 40 mg (IQR: 40-80). The results of the multivariable analysis showed that New York Heart Association classes III and IV and diabetes mellitus were one of the strongest determinants of an FDE >80 mg, across all HF categories. Renal impairment was associated with a higher FDE across the entire EF spectrum. CONCLUSION: In this large registry of real-world HF patients, LD use was highest among HFrEF patients. Advanced symptoms, diabetes mellitus and worse renal function were significantly associated with a higher diuretic dose regardless of left ventricular ejection fraction.


Subject(s)
Diabetes Mellitus , Heart Failure , Humans , Heart Failure/diagnosis , Heart Failure/drug therapy , Heart Failure/complications , Sodium Potassium Chloride Symporter Inhibitors/adverse effects , Stroke Volume , Ventricular Function, Left , Prognosis , Furosemide/adverse effects , Diuretics/adverse effects
2.
Eur J Clin Invest ; 53(7): e13976, 2023 Jul.
Article in English | MEDLINE | ID: mdl-36841951

ABSTRACT

BACKGROUND: The aim of this study was to assess heart failure (HF) treatment in patients with and without obesity in a large contemporary real-world Western European cohort. METHODS: Patients with a left ventricular ejection fraction (LVEF) <50% and available information on body mass index (BMI) were selected from the CHECK-HF registry. The CHECK-HF registry included chronic HF patients in the period between 2013 and 2016 in 34 Dutch outpatient clinics. Patients were divided into BMI categories. Differences in HF medical treatment were analysed, and multivariable logistic regression analysis (dichotomized as BMI <30 kg/m2 and ≥30 kg/m2 ) was performed. RESULTS: Seven thousand six hundred seventy-one patients were included, 1284 (16.7%) had a BMI ≥30 kg/m2 , and 618 (8.1%) had a BMI ≥35 kg/m2 . Median BMI was 26.4 kg/m2 . Patients with obesity were younger and had a higher rate of comorbidities such as diabetes mellitus, hypertension and obstructive sleep apnoea (OSAS). Prescription rates of guideline-directed medical therapy (GDMT) increased significantly with BMI. The differences were most pronounced for mineralocorticoid receptor antagonists (MRAs) and diuretics. Patients with obesity more often received the guideline-recommended target dose. In multivariable logistic regression, obesity was significantly associated with a higher likelihood of receiving ≥100% of the guideline-recommended target dose of beta-blockers (OR 1.34, 95% CI 1.10-1.62), renin-angiotensin system (RAS)-inhibitors (OR 1.34, 95% CI 1.15-1.57) and MRAs (OR 1.40, 95% CI 1.04-1.87). CONCLUSIONS: Guideline-recommended HF drugs are more frequently prescribed and at a higher dose in patients with obesity as compared to HF patients without obesity.


Subject(s)
Heart Failure , Ventricular Function, Left , Humans , Stroke Volume , Treatment Outcome , Heart Failure/drug therapy , Heart Failure/epidemiology , Adrenergic beta-Antagonists/therapeutic use , Mineralocorticoid Receptor Antagonists/therapeutic use , Obesity/complications , Obesity/epidemiology , Obesity/drug therapy , Angiotensin Receptor Antagonists/therapeutic use
3.
Int J Cardiol ; 308: 60-66, 2020 06 01.
Article in English | MEDLINE | ID: mdl-32173129

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) is common in chronic heart failure (HF) patients and influences the choice and effects of drug and device therapy. In this large real-world HF registry, we studied whether the presence of AF affects the prescription of guideline-recommended HF therapy. METHODS: We analyzed 8253 patients with chronic HF with reduced ejection fraction (HFrEF) from 34 Dutch outpatient clinics included in the period between 2013 and 2016 treated according to the 2012 ESC guidelines. RESULTS: 2109 (25.6%) of these patients were in AF (mean age 76.8 ± 9.2 years, 65.0% were men) and 6.144 (74.4%) had no AF (mean age 70.7 ± 12.2 years, 63.6% were men). Patients with AF more often received beta-blockers (81.7% vs. 79.7%, p = 0.04), MRAs (57.1% vs. 51.7%, p < 0.01), diuretics (89.7% vs. 80.6%, p < 0.01) and digoxin (40.1% vs. 9.3%, p < 0.01) compared to patients without AF, whereas they less often receive renin-angiotensin-system (RAS)-inhibitors (76.1% vs. 83.1%, p < 0.01). The number of patients who received beta-blockers, RAS-inhibitor and MRA at ≥50% of the recommended target dose was comparable between those with and without AF (16.6% vs. 15.2%, p = 0.07). CONCLUSION: In this large cohort of chronic HFrEF patients, the prevalence of AF was high and we observed significant differences in prescription of both guideline-recommended HF between patients with and without AF.


Subject(s)
Atrial Fibrillation , Heart Failure , Adrenergic beta-Antagonists/therapeutic use , Aged , Aged, 80 and over , Atrial Fibrillation/diagnosis , Atrial Fibrillation/drug therapy , Atrial Fibrillation/epidemiology , Female , Heart Failure/diagnosis , Heart Failure/drug therapy , Heart Failure/epidemiology , Humans , Male , Middle Aged , Registries , Stroke Volume
4.
JACC Heart Fail ; 7(1): 13-21, 2019 01.
Article in English | MEDLINE | ID: mdl-30606482

ABSTRACT

OBJECTIVES: This study investigated adherence to drug therapy guidelines in heart failure (HF) with reduced left-ventricular ejection fraction (LVEF) of <40% (heart failure with reduced ejection fraction [HFrEF]), in which evidence-based treatment has been established. BACKGROUND: Despite previous surveys of HF, important uncertainties remain regarding guideline adherence in a representative real-world population. METHODS: A cross-sectional registry in 34 Dutch HF outpatient clinics that included 10,910 patients with the diagnosis of HF was examined. Of that number, 8,360 patients had LVEF <50% (72 ± 12 years of age; 64% male) and were divided into HFrEF (n = 5,701), HF with mid-range LVEF (HFmrEF) with LVEF 40% to 49% (n = 1,574), and those with semiquantitatively measured LVEF but <50% (n = 1,085). RESULTS: In the HFrEF group, 81% of the patients were treated with loop diuretics, 84% with renin-angiotensin-system (RAS) inhibitors, 86% with ß-blockers, 56% with mineralocorticoid-receptor antagonists (MRA), and 5% with If-channel inhibition. Differences in medication use were minor among the 3 groups but were significant among centers. Inability to tolerate the medications was recorded in 9.4% patients taking RAS inhibitors, 3.3% taking ß-blockers, and 5.4% taking MRAs. Median loop diuretic dose was 40 mg of furosemide equivalent, RAS inhibitor dose 50% of target, ß-blocker dose 25% of target, and MRA dose 12.5 mg of spironolactone equivalent. Elderly patients were treated predominantly with diuretics and less often with RAS inhibitors, ß-blockers, and MRAs. CONCLUSIONS: This large contemporary HF registry showed a relatively high use of evidence-based treatment, particularly in younger patients. However, the average dose of evidence-based medication was still lower than recommended by guidelines. Furthermore, the more recently introduced If-channel inhibition has hardly been adopted. There is ample room for improvement of HFrEF therapy, even more than 25 years after convincing evidence that HFrEF treatment leads to better outcome.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Cardiovascular Agents/therapeutic use , Guideline Adherence/statistics & numerical data , Heart Failure/drug therapy , Mineralocorticoid Receptor Antagonists/therapeutic use , Sodium Potassium Chloride Symporter Inhibitors/therapeutic use , Stroke Volume , Age Factors , Aged , Aged, 80 and over , Chronic Disease , Cross-Sectional Studies , Female , Furosemide/therapeutic use , Heart Failure/physiopathology , Humans , Ivabradine/therapeutic use , Male , Middle Aged , Netherlands , Practice Guidelines as Topic , Registries , Renin-Angiotensin System , Spironolactone/therapeutic use
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