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. 2023 May;11(5):596-606.
doi: 10.1016/j.jchf.2022.10.013. Epub 2023 Jan 11.

Patient Eligibility for Established and Novel Guideline-Directed Medical Therapies After Acute Heart Failure Hospitalization

Nima Moghaddam  1 , Nathaniel M Hawkins  2 , Robert McKelvie  3 , Stephanie Poon  4 , Sebastien Xavier Joncas  5 , John MacFadyen  6 , George Honos  7 , Jia Wang  8 , Carlos Rojas-Fernandez  9 , Melanie Kok  9 , Vishaldeep Sidhu  8 , Shelley Zieroth  10 , Sean A Virani  11
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Free article

Patient Eligibility for Established and Novel Guideline-Directed Medical Therapies After Acute Heart Failure Hospitalization

Nima Moghaddam et al. JACC Heart Fail. 2023 May.
Free article

Abstract

Background: Acute heart failure (AHF) hospitalization presents an opportunity to optimize pharmacotherapy to improve outcomes.

Objectives: This study's aim was to define eligibility for initiation of guideline-directed medical therapy and newer heart failure (HF) agents from recent clinical trials in the AHF population.

Methods: The authors analyzed patients with an AHF admission within the CAN-HF (Canadian Heart Failure) registry between January 2017 and April 2020. Heart failure with reduced ejection fraction (HFrEF) was defined as left ventricular ejection fraction (LVEF) ≤40% and heart failure with preserved ejection fraction (HFpEF) as LVEF >40%. Eligibility was assessed according to the major society guidelines or enrollment criteria from recent landmark clinical trials.

Results: A total of 809 patients with documented LVEF were discharged alive from hospital: 455 with HFrEF and 354 with HFpEF; of these patients, 284 had a de novo presentation and 525 had chronic HF. In HFrEF patients, eligibility for therapies was 73.6% for angiotensin receptor-neprilysin inhibitors (ARNIs), 94.9% for beta-blockers, 84.4% for mineralocorticoid receptor antagonists (MRAs), 81.1% for sodium-glucose cotransporter-2 (SGLT2) inhibitors, and 15.6% for ivabradine. Additionally, 25.9% and 30.1% met trial criteria for vericiguat and omecamtiv mecarbil, respectively. Overall, 71.6% of patients with HFrEF (75.5% de novo, 69.5% chronic HF) were eligible for foundational quadruple therapy. In the HFpEF population, 37.6% and 59.9% were eligible for ARNIs and SGLT2 inhibitors based on recent trial criteria, respectively.

Conclusions: The majority of patients admitted with AHF are eligible for foundational quadruple therapy and additional novel medications across a spectrum of HF phenotypes.

Keywords: eligibility; guideline-directed medical therapy; heart failure.

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Conflict of interest statement

Funding Support and Author Disclosures CAN-HF was funded by Novartis Canada. This study was supported by the Canadian Cardiovascular Institute (CCI-CIC). Dr Hawkins has received speaker and research fees from Novartis; and has received speaker fees from Boehringer Ingelheim. Dr McKelvie has received speaker and research fees from Novartis, Boehringer Ingelheim, AstraZeneca, and Bayer. Dr Joncas has received research grant support or served on advisory boards for and speaking engagements with AstraZeneca, Amgen, Bayer, Boehringer Ingelheim, Novartis, Pfizer, and Servier. Dr Zieroth has received research grant support or served on advisory boards for and speaking engagements with Abbott, Akcea, AstraZeneca, Amgen, Alnylam, Bayer, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novartis, Novo Nordisk, Otsuka, Pfizer, Servier, and Vifor; and serves on a clinical trial steering committee or as a National Lead for studies sponsored by AstraZeneca, Boehringer Ingelheim, Novartis, and Merck. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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