Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Accelerated and personalized therapy for heart failure with reduced ejection fraction

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Polygenic risk score for ACE-inhibitor-associated cough based on the discovery of new genetic loci

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Pharmacogenetics-guided CETP inhibition: an open question?

    Research output: Contribution to journalEditorialResearchpeer-review

  4. Primary lifestyle intervention: the challenge of making a difference

    Research output: Contribution to journalEditorialResearchpeer-review

  5. A double negative: culture-negative infective endocarditis

    Research output: Contribution to journalEditorialResearchpeer-review

  1. Polygenic risk score for ACE-inhibitor-associated cough based on the discovery of new genetic loci

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Diagnostic and prognostic value of the electrocardiogram in stable outpatients with type 2 diabetes

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Long-term effects of cardiac rehabilitation after heart valve surgery - results from the randomised CopenHeartVR trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  • Li Shen
  • Pardeep Singh Jhund
  • Kieran Francis Docherty
  • Muthiah Vaduganathan
  • Mark Colquhoun Petrie
  • Akshay Suvas Desai
  • Lars Køber
  • Morten Schou
  • Milton Packer
  • Scott David Solomon
  • Xingwei Zhang
  • John Joseph Valentine McMurray
View graph of relations

AIMS: Previously, guidelines recommended initiating therapy in patients with heart failure and reduced ejection fraction (HFrEF) in a sequence that follows the chronological order in which trials were conducted, with cautious up-titration of each treatment. It remains unclear whether this historical approach is optimal and alternative approaches may improve patient outcomes.

METHODS AND RESULTS: The potential reductions in events that might result from (i) more rapid up-titration of therapies used in the conventional order (based on the chronology of the trials), and (ii) accelerated up-titration and using treatments in different orders than is conventional were modelled using data from six pivotal trials in HFrEF. Over the first 12 months from starting therapy, using a rapid up-titration schedule led to 23 fewer patients per 1000 patients experiencing the composite of heart failure hospitalization or cardiovascular death and seven fewer deaths from any cause. In addition to accelerating up-titration of treatments, optimized alternative ordering of the drugs used resulted in a further reduction of 24 patients experiencing the composite outcome and six fewer deaths at 12 months. The optimal alternative sequences included sodium-glucose cotransporter 2 inhibition and a mineralocorticoid receptor antagonist as the first two therapies.

CONCLUSION: Modelling of accelerated up-titration schedule and optimized ordering of treatment suggested that at least 14 deaths and 47 patients experiencing the composite outcome per 1000 treated might be prevented over the first 12 months after starting therapy. Standard treatment guidance may not lead to the best patient outcomes in HFrEF, though these findings should be tested in clinical trials.

Original languageEnglish
JournalEuropean Heart Journal
Volume43
Issue number27
Pages (from-to)2573-2587
Number of pages15
ISSN0195-668X
DOIs
Publication statusPublished - 14 Jul 2022

Bibliographical note

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

    Research areas

  • Heart Failure/drug therapy, Hospitalization, Humans, Mineralocorticoid Receptor Antagonists/therapeutic use, Stroke Volume/physiology, Ventricular Dysfunction, Left/drug therapy

ID: 77899961