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1/ Excited to present our work evaluating the impact of heart failure hospitalization (HFH) on GDMT prescribing patterns in those with HFrEF.
http://jacc.org/doi/10.1016/j.jchf.2020.08.017
@gcfmd @_adevore @nancy_m_albert @JavedButler1 @jspertus @texhern @JACCJournals
http://jacc.org/doi/10.1016/j.jchf.2020.08.017
@gcfmd @_adevore @nancy_m_albert @JavedButler1 @jspertus @texhern @JACCJournals
2/ HFH represents an important event in the disease trajectory of HFrEF patients, and serves as an opportunity to optimize guideline-directed medical therapy (GDMT). Initiating/continuing GDMT in appropriate hospitalized patients is safe, and improves long-term outcomes.
3/ Using 4,365 patients enrolled in the national #CHAMP-HF registry, we sought to evaluate the impact of HFH on GDMT (ACEI/ARB/ARNI, BB, MRA) prescribing patterns among those with a history of HFrEF.
4/ Patients with HFH (compared to no HFH) were younger, had lower ejection fractions, and a greater number of cardiac and non-cardiac comorbidities.
5/ HFH (compared to no HFH) associated with increased likelihood of initiation of all GDMT classes, and with dose escalation of ACEI/ARB/MRA. HFH also associated with increased likelihood of de-escalation/discontinuation of all classes of GDMT in those on prior therapy.
6/ GDMT de-escalation/discontinuation after HFH associated with increased likelihood of all-cause mortality.
7/ Educational endeavors in the inpatient setting may prevent inappropriate de-escalation/discontinuation of GDMT. For presentations that mandate dose change, electronic medical system reminders at discharge may prompt re-initiation/up-titration.
8/ For those that cannot tolerate GDMT during HFH, post-discharge HF clinics/PCP follow up visits present opportunities to re-optimize GDMT.
9/ Take Home Points
-HFH represents an opportunity to optimize GDMT
-in this analysis, HFH associated with both GDMT initiation/dose escalation and GDMT discontinuation/dose de-escalation
-patients with discontinuation/de-escalation were found to have worse long-term outcomes
-HFH represents an opportunity to optimize GDMT
-in this analysis, HFH associated with both GDMT initiation/dose escalation and GDMT discontinuation/dose de-escalation
-patients with discontinuation/de-escalation were found to have worse long-term outcomes
10/ Also check out @ersied727 and @mfiuzat‘s terrific editorial where they propose an Optimal Medical Therapy score to evaluate GDMT regimens.
