Improvement in left ventricular ejection fraction after pharmacological up-titration in new-onset heart failure with reduced ejection fraction
Objective Recent studies have reported suboptimal up-titration of heart failure (HF) therapies in patients with heart failure and a reduced ejection fraction (HFrEF). Here, we report on the achieved doses after nurse-led up-titration, reasons for not achieving the target dose, subsequent changes in...
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| Veröffentlicht in: | Netherlands heart journal 2021-07, Vol.29 (7-8), p.383-393 |
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| creator | Nauta, J. F. Santema, B. T. van der Wal, M. H. L. Koops, A. Warink-Riemersma, J. van Dijk, K. Inkelaar, F. Prückl, S. Suwijn, J. van Deursen, V. M. Meijers, W. C. Coster, J. Westenbrink, B. D. de Boer, R. A. Hummel, Y. van Melle, J. van Veldhuisen, D. J. van der Meer, P. Voors, A. A. |
| description | Objective
Recent studies have reported suboptimal up-titration of heart failure (HF) therapies in patients with heart failure and a reduced ejection fraction (HFrEF). Here, we report on the achieved doses after nurse-led up-titration, reasons for not achieving the target dose, subsequent changes in left ventricular ejection fraction (LVEF), and mortality.
Methods
From 2012 to 2018, 378 HFrEF patients with a recent ( |
| doi_str_mv | 10.1007/s12471-021-01591-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8271074</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2540729033</sourcerecordid><originalsourceid>FETCH-LOGICAL-c451t-915f5f0124c5e4f0290f40dd863091eebd0bdc3f306165d1707af04817ba5eb83</originalsourceid><addsrcrecordid>eNp9kUFrFTEUhQex2Fr9A64CbtxEb5LJZN5GkKJtodBNuw6ZzM17ecxMxiTzSv-Ev9m8TlFUcBFyQ75zuIdTVe8YfGQA6lNivFaMAi-HyQ2jzYvqjLWqoQ2X8LLMsmmpbNv2tHqd0h5AKs7Uq-pU1IxLIcVZ9eN6nGM44IhTJn4iA7pMDuURvV0GEwnu0WYfJuKiWQfjMkYy70wcjQ1D2HprBrLMNPsczRNSjCZ8oGFKmMkOTczEGT8sEcmDzzsSsV8s9v-av6lOnBkSvn2-z6v7b1_vLq7oze3l9cWXG2pryTLdMOmkg5LfSqwd8A24Gvq-bQRsGGLXQ9db4QQ0rJE9U6CMg7plqjMSu1acV59X33npRuztMbAZ9Bz9aOKjDsbrP38mv9PbcNAtVwxUXQw-PBvE8H3BlPXok8VhMBOGJWkua1BlLSEK-v4vdB-WOJV4mhdEClGrI8VXysaQUkT3axkG-li3XuvWpW79VLduikisolTgaYvxt_V_VD8BBQ-v5w</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2729533473</pqid></control><display><type>article</type><title>Improvement in left ventricular ejection fraction after pharmacological up-titration in new-onset heart failure with reduced ejection fraction</title><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>Springer Nature OA/Free Journals</source><creator>Nauta, J. F. ; Santema, B. T. ; van der Wal, M. H. L. ; Koops, A. ; Warink-Riemersma, J. ; van Dijk, K. ; Inkelaar, F. ; Prückl, S. ; Suwijn, J. ; van Deursen, V. M. ; Meijers, W. C. ; Coster, J. ; Westenbrink, B. D. ; de Boer, R. A. ; Hummel, Y. ; van Melle, J. ; van Veldhuisen, D. J. ; van der Meer, P. ; Voors, A. A.</creator><creatorcontrib>Nauta, J. F. ; Santema, B. T. ; van der Wal, M. H. L. ; Koops, A. ; Warink-Riemersma, J. ; van Dijk, K. ; Inkelaar, F. ; Prückl, S. ; Suwijn, J. ; van Deursen, V. M. ; Meijers, W. C. ; Coster, J. ; Westenbrink, B. D. ; de Boer, R. A. ; Hummel, Y. ; van Melle, J. ; van Veldhuisen, D. J. ; van der Meer, P. ; Voors, A. A.</creatorcontrib><description>Objective
Recent studies have reported suboptimal up-titration of heart failure (HF) therapies in patients with heart failure and a reduced ejection fraction (HFrEF). Here, we report on the achieved doses after nurse-led up-titration, reasons for not achieving the target dose, subsequent changes in left ventricular ejection fraction (LVEF), and mortality.
Methods
From 2012 to 2018, 378 HFrEF patients with a recent (< 3 months) diagnosis of HF were referred to a specialised HF-nurse led clinic for protocolised up-titration of guideline-directed medical therapy (GDMT). The achieved doses of GDMT at 9 months were recorded, as well as reasons for not achieving the optimal dose in all patients. Echocardiography was performed at baseline and after up-titration in 278 patients.
Results
Of 345 HFrEF patients with a follow-up visit after 9 months, 69% reached ≥ 50% of the recommended dose of renin-angiotensin-system (RAS) inhibitors, 73% reached ≥ 50% of the recommended dose of beta-blockers and 77% reached ≥ 50% of the recommended dose of mineralocorticoid receptor antagonists. The main reasons for not reaching the target dose were hypotension (RAS inhibitors and beta-blockers), bradycardia (beta-blockers) and renal dysfunction (RAS inhibitors). During a median follow-up of 9 months, mean LVEF increased from 27.6% at baseline to 38.8% at follow-up. Each 5% increase in LVEF was associated with an adjusted hazard ratio of 0.84 (0.75–0.94,
p
= 0.002) for mortality and 0.85 (0.78–0.94,
p
= 0.001) for the combined endpoint of mortality and/or HF hospitalisation after a mean follow-up of 3.3 years.
Conclusions
This study shows that protocolised up-titration in a nurse-led HF clinic leads to high doses of GDMT and improvement of LVEF in patients with new-onset HFrEF.</description><identifier>ISSN: 1568-5888</identifier><identifier>EISSN: 1876-6250</identifier><identifier>DOI: 10.1007/s12471-021-01591-6</identifier><identifier>PMID: 34125353</identifier><language>eng</language><publisher>Houten: Bohn Stafleu van Loghum</publisher><subject>Activities of daily living ; Beta blockers ; Cardiac arrhythmia ; Cardiology ; Chronic obstructive pulmonary disease ; Clinics ; Drug dosages ; Ejection fraction ; Electrocardiography ; Enzymes ; Heart failure ; Hospitalization ; Hypotension ; Laboratories ; Medical Education ; Medicine ; Medicine & Public Health ; Mortality ; Nurses ; Original ; Original Article ; Outpatient care facilities ; Patients ; Ultrasonic imaging</subject><ispartof>Netherlands heart journal, 2021-07, Vol.29 (7-8), p.383-393</ispartof><rights>The Author(s) 2021</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-915f5f0124c5e4f0290f40dd863091eebd0bdc3f306165d1707af04817ba5eb83</citedby><cites>FETCH-LOGICAL-c451t-915f5f0124c5e4f0290f40dd863091eebd0bdc3f306165d1707af04817ba5eb83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8271074/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8271074/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,41119,42188,51575,53790,53792</link.rule.ids></links><search><creatorcontrib>Nauta, J. F.</creatorcontrib><creatorcontrib>Santema, B. T.</creatorcontrib><creatorcontrib>van der Wal, M. H. L.</creatorcontrib><creatorcontrib>Koops, A.</creatorcontrib><creatorcontrib>Warink-Riemersma, J.</creatorcontrib><creatorcontrib>van Dijk, K.</creatorcontrib><creatorcontrib>Inkelaar, F.</creatorcontrib><creatorcontrib>Prückl, S.</creatorcontrib><creatorcontrib>Suwijn, J.</creatorcontrib><creatorcontrib>van Deursen, V. M.</creatorcontrib><creatorcontrib>Meijers, W. C.</creatorcontrib><creatorcontrib>Coster, J.</creatorcontrib><creatorcontrib>Westenbrink, B. D.</creatorcontrib><creatorcontrib>de Boer, R. A.</creatorcontrib><creatorcontrib>Hummel, Y.</creatorcontrib><creatorcontrib>van Melle, J.</creatorcontrib><creatorcontrib>van Veldhuisen, D. J.</creatorcontrib><creatorcontrib>van der Meer, P.</creatorcontrib><creatorcontrib>Voors, A. A.</creatorcontrib><title>Improvement in left ventricular ejection fraction after pharmacological up-titration in new-onset heart failure with reduced ejection fraction</title><title>Netherlands heart journal</title><addtitle>Neth Heart J</addtitle><description>Objective
Recent studies have reported suboptimal up-titration of heart failure (HF) therapies in patients with heart failure and a reduced ejection fraction (HFrEF). Here, we report on the achieved doses after nurse-led up-titration, reasons for not achieving the target dose, subsequent changes in left ventricular ejection fraction (LVEF), and mortality.
Methods
From 2012 to 2018, 378 HFrEF patients with a recent (< 3 months) diagnosis of HF were referred to a specialised HF-nurse led clinic for protocolised up-titration of guideline-directed medical therapy (GDMT). The achieved doses of GDMT at 9 months were recorded, as well as reasons for not achieving the optimal dose in all patients. Echocardiography was performed at baseline and after up-titration in 278 patients.
Results
Of 345 HFrEF patients with a follow-up visit after 9 months, 69% reached ≥ 50% of the recommended dose of renin-angiotensin-system (RAS) inhibitors, 73% reached ≥ 50% of the recommended dose of beta-blockers and 77% reached ≥ 50% of the recommended dose of mineralocorticoid receptor antagonists. The main reasons for not reaching the target dose were hypotension (RAS inhibitors and beta-blockers), bradycardia (beta-blockers) and renal dysfunction (RAS inhibitors). During a median follow-up of 9 months, mean LVEF increased from 27.6% at baseline to 38.8% at follow-up. Each 5% increase in LVEF was associated with an adjusted hazard ratio of 0.84 (0.75–0.94,
p
= 0.002) for mortality and 0.85 (0.78–0.94,
p
= 0.001) for the combined endpoint of mortality and/or HF hospitalisation after a mean follow-up of 3.3 years.
Conclusions
This study shows that protocolised up-titration in a nurse-led HF clinic leads to high doses of GDMT and improvement of LVEF in patients with new-onset HFrEF.</description><subject>Activities of daily living</subject><subject>Beta blockers</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Clinics</subject><subject>Drug dosages</subject><subject>Ejection fraction</subject><subject>Electrocardiography</subject><subject>Enzymes</subject><subject>Heart failure</subject><subject>Hospitalization</subject><subject>Hypotension</subject><subject>Laboratories</subject><subject>Medical Education</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Nurses</subject><subject>Original</subject><subject>Original Article</subject><subject>Outpatient care facilities</subject><subject>Patients</subject><subject>Ultrasonic imaging</subject><issn>1568-5888</issn><issn>1876-6250</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kUFrFTEUhQex2Fr9A64CbtxEb5LJZN5GkKJtodBNuw6ZzM17ecxMxiTzSv-Ev9m8TlFUcBFyQ75zuIdTVe8YfGQA6lNivFaMAi-HyQ2jzYvqjLWqoQ2X8LLMsmmpbNv2tHqd0h5AKs7Uq-pU1IxLIcVZ9eN6nGM44IhTJn4iA7pMDuURvV0GEwnu0WYfJuKiWQfjMkYy70wcjQ1D2HprBrLMNPsczRNSjCZ8oGFKmMkOTczEGT8sEcmDzzsSsV8s9v-av6lOnBkSvn2-z6v7b1_vLq7oze3l9cWXG2pryTLdMOmkg5LfSqwd8A24Gvq-bQRsGGLXQ9db4QQ0rJE9U6CMg7plqjMSu1acV59X33npRuztMbAZ9Bz9aOKjDsbrP38mv9PbcNAtVwxUXQw-PBvE8H3BlPXok8VhMBOGJWkua1BlLSEK-v4vdB-WOJV4mhdEClGrI8VXysaQUkT3axkG-li3XuvWpW79VLduikisolTgaYvxt_V_VD8BBQ-v5w</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Nauta, J. F.</creator><creator>Santema, B. T.</creator><creator>van der Wal, M. H. L.</creator><creator>Koops, A.</creator><creator>Warink-Riemersma, J.</creator><creator>van Dijk, K.</creator><creator>Inkelaar, F.</creator><creator>Prückl, S.</creator><creator>Suwijn, J.</creator><creator>van Deursen, V. M.</creator><creator>Meijers, W. C.</creator><creator>Coster, J.</creator><creator>Westenbrink, B. D.</creator><creator>de Boer, R. A.</creator><creator>Hummel, Y.</creator><creator>van Melle, J.</creator><creator>van Veldhuisen, D. J.</creator><creator>van der Meer, P.</creator><creator>Voors, A. A.</creator><general>Bohn Stafleu van Loghum</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210701</creationdate><title>Improvement in left ventricular ejection fraction after pharmacological up-titration in new-onset heart failure with reduced ejection fraction</title><author>Nauta, J. F. ; Santema, B. T. ; van der Wal, M. H. L. ; Koops, A. ; Warink-Riemersma, J. ; van Dijk, K. ; Inkelaar, F. ; Prückl, S. ; Suwijn, J. ; van Deursen, V. M. ; Meijers, W. C. ; Coster, J. ; Westenbrink, B. D. ; de Boer, R. A. ; Hummel, Y. ; van Melle, J. ; van Veldhuisen, D. J. ; van der Meer, P. ; Voors, A. A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-915f5f0124c5e4f0290f40dd863091eebd0bdc3f306165d1707af04817ba5eb83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Activities of daily living</topic><topic>Beta blockers</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Clinics</topic><topic>Drug dosages</topic><topic>Ejection fraction</topic><topic>Electrocardiography</topic><topic>Enzymes</topic><topic>Heart failure</topic><topic>Hospitalization</topic><topic>Hypotension</topic><topic>Laboratories</topic><topic>Medical Education</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Nurses</topic><topic>Original</topic><topic>Original Article</topic><topic>Outpatient care facilities</topic><topic>Patients</topic><topic>Ultrasonic imaging</topic><toplevel>online_resources</toplevel><creatorcontrib>Nauta, J. F.</creatorcontrib><creatorcontrib>Santema, B. T.</creatorcontrib><creatorcontrib>van der Wal, M. H. L.</creatorcontrib><creatorcontrib>Koops, A.</creatorcontrib><creatorcontrib>Warink-Riemersma, J.</creatorcontrib><creatorcontrib>van Dijk, K.</creatorcontrib><creatorcontrib>Inkelaar, F.</creatorcontrib><creatorcontrib>Prückl, S.</creatorcontrib><creatorcontrib>Suwijn, J.</creatorcontrib><creatorcontrib>van Deursen, V. M.</creatorcontrib><creatorcontrib>Meijers, W. C.</creatorcontrib><creatorcontrib>Coster, J.</creatorcontrib><creatorcontrib>Westenbrink, B. D.</creatorcontrib><creatorcontrib>de Boer, R. A.</creatorcontrib><creatorcontrib>Hummel, Y.</creatorcontrib><creatorcontrib>van Melle, J.</creatorcontrib><creatorcontrib>van Veldhuisen, D. J.</creatorcontrib><creatorcontrib>van der Meer, P.</creatorcontrib><creatorcontrib>Voors, A. A.</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Netherlands heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nauta, J. F.</au><au>Santema, B. T.</au><au>van der Wal, M. H. L.</au><au>Koops, A.</au><au>Warink-Riemersma, J.</au><au>van Dijk, K.</au><au>Inkelaar, F.</au><au>Prückl, S.</au><au>Suwijn, J.</au><au>van Deursen, V. M.</au><au>Meijers, W. C.</au><au>Coster, J.</au><au>Westenbrink, B. D.</au><au>de Boer, R. A.</au><au>Hummel, Y.</au><au>van Melle, J.</au><au>van Veldhuisen, D. J.</au><au>van der Meer, P.</au><au>Voors, A. A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improvement in left ventricular ejection fraction after pharmacological up-titration in new-onset heart failure with reduced ejection fraction</atitle><jtitle>Netherlands heart journal</jtitle><stitle>Neth Heart J</stitle><date>2021-07-01</date><risdate>2021</risdate><volume>29</volume><issue>7-8</issue><spage>383</spage><epage>393</epage><pages>383-393</pages><issn>1568-5888</issn><eissn>1876-6250</eissn><abstract>Objective
Recent studies have reported suboptimal up-titration of heart failure (HF) therapies in patients with heart failure and a reduced ejection fraction (HFrEF). Here, we report on the achieved doses after nurse-led up-titration, reasons for not achieving the target dose, subsequent changes in left ventricular ejection fraction (LVEF), and mortality.
Methods
From 2012 to 2018, 378 HFrEF patients with a recent (< 3 months) diagnosis of HF were referred to a specialised HF-nurse led clinic for protocolised up-titration of guideline-directed medical therapy (GDMT). The achieved doses of GDMT at 9 months were recorded, as well as reasons for not achieving the optimal dose in all patients. Echocardiography was performed at baseline and after up-titration in 278 patients.
Results
Of 345 HFrEF patients with a follow-up visit after 9 months, 69% reached ≥ 50% of the recommended dose of renin-angiotensin-system (RAS) inhibitors, 73% reached ≥ 50% of the recommended dose of beta-blockers and 77% reached ≥ 50% of the recommended dose of mineralocorticoid receptor antagonists. The main reasons for not reaching the target dose were hypotension (RAS inhibitors and beta-blockers), bradycardia (beta-blockers) and renal dysfunction (RAS inhibitors). During a median follow-up of 9 months, mean LVEF increased from 27.6% at baseline to 38.8% at follow-up. Each 5% increase in LVEF was associated with an adjusted hazard ratio of 0.84 (0.75–0.94,
p
= 0.002) for mortality and 0.85 (0.78–0.94,
p
= 0.001) for the combined endpoint of mortality and/or HF hospitalisation after a mean follow-up of 3.3 years.
Conclusions
This study shows that protocolised up-titration in a nurse-led HF clinic leads to high doses of GDMT and improvement of LVEF in patients with new-onset HFrEF.</abstract><cop>Houten</cop><pub>Bohn Stafleu van Loghum</pub><pmid>34125353</pmid><doi>10.1007/s12471-021-01591-6</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1568-5888 |
| ispartof | Netherlands heart journal, 2021-07, Vol.29 (7-8), p.383-393 |
| issn | 1568-5888 1876-6250 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8271074 |
| source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection; Springer Nature OA/Free Journals |
| subjects | Activities of daily living Beta blockers Cardiac arrhythmia Cardiology Chronic obstructive pulmonary disease Clinics Drug dosages Ejection fraction Electrocardiography Enzymes Heart failure Hospitalization Hypotension Laboratories Medical Education Medicine Medicine & Public Health Mortality Nurses Original Original Article Outpatient care facilities Patients Ultrasonic imaging |
| title | Improvement in left ventricular ejection fraction after pharmacological up-titration in new-onset heart failure with reduced ejection fraction |
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