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. 2023 Mar 9:14:1081579.
doi: 10.3389/fphar.2023.1081579. eCollection 2023.

Phenotypic patient profiling for improved implementation of guideline-directed medical therapy: An exploratory analysis in a large real-world chronic heart failure cohort

Sumant P Radhoe  1 , Pascal R D Clephas  1 , Gerard C M Linssen  2 , Remko M Oortman  3 , Frank J Smeele  4 , Annemarie A Van Drimmelen  5 , Henk-Jan Schaafsma  6 , Paul H Westendorp  7 , Hans-Peter Brunner-La Rocca  8 , Jasper J Brugts  1
Affiliations

Phenotypic patient profiling for improved implementation of guideline-directed medical therapy: An exploratory analysis in a large real-world chronic heart failure cohort

Sumant P Radhoe et al. Front Pharmacol. .

Abstract

Aims: Implementation of guideline-recommended pharmacological treatment in heart failure (HF) patients remains challenging. In 2021, the European Heart Failure Association (HFA) published a consensus document in which patient profiles were created based on readily available patient characteristics and suggested that treatment adjusted to patient profile may result in better individualized treatment and improved guideline adherence. This study aimed to assess the distribution of these patient profiles and their treatment in a large real-world chronic HF cohort. Methods and results: The HFA combined categories of heart rate, blood pressure, presence of atrial fibrillation, chronic kidney disease, and hyperkalemia into eleven phenotypic patient profiles. A total of 4,455 patients with chronic HF and a left ventricular ejection fraction ≤40% with complete information on all characteristics were distributed over these profiles. In total, 1,640 patients (36.8%) could be classified into one of the HFA profiles. Three of these each comprised >5% of the population and consisted of patients with a heart rate >60 beats per minute with normal blood pressure (>90/60 mmHg) and no hyperkalemia. Conclusion: Nearly forty percent of a real-world chronic HF population could be distributed over the eleven patient profiles as suggested by the HFA. Phenotype-specific treatment recommendations are clinically relevant and important to further improve guideline implementation.

Keywords: clinical profiles; guideline implementation; guideline-directed medical therapy; heart failure; personalized medicine; pharmacotherapy; phenotype.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Overview of the eleven patient profiles as proposed by the Heart Failure Association. Reprinted from European Journal of Heart Failure, Volume 23, Issue 6, Rosano et al., Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology, Pages 872–881, Copyright 2021, with permission from Wiley. (Rosano et al., 2021).
FIGURE 2
FIGURE 2
Distribution of the patient characteristics in a real-world chronic heart failure cohort.
FIGURE 3
FIGURE 3
Prevalence of the patient profiles as proposed by the Heart Failure Association.
See this image and copyright information in PMC

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