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heart failure ace arb

Poghni A Peri-Okonny, Xiaojuan Mi, Yevgeniy Khariton, Krishna K Patel, Laine Thomas, Gregg C Fonarow, Puza P Sharma, Carol I Duffy, Nancy M Albert, Javed Butler, Adrian F Hernandez, Kevin McCague, Fredonia B Williams, Adam D DeVore, J Herbert Patterson, John A Spertus
OBJECTIVES: This study sought to determine the rate of use of target doses of foundational guideline-directed medical therapy (GDMT) in a contemporary cohort of patients with heart failure with reduced ejection fraction (HFrEF) across systolic blood pressure (SBP) categories. BACKGROUND: Patients with HFrEF are infrequently titrated to recommended doses of GDMT. The relationship between SBP and achieving GDMT target doses is not well studied. METHODS: Patients enrolled in the CHAMP-HF (Change the Management of Patients With Heart Failure) registry without documented intolerance to angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), and beta blockers (BBs) were assessed at enrollment...
February 4, 2019: JACC. Heart Failure
Jose J Egido, Rocio Gomez, Sotero P Romero, Jose L Andrey, Daniel Ramirez, Ana Rodriguez, Maria J Pedrosa, Francisco Gomez
AIMS: There is currently no consensus on the effect of treatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), on the prognosis of patients with heart failure and preserved ejection fraction (HFpEF). Therefore, we have analyzed the relationship of commencing treatment with ACEIs or ARBs and the prognosis of patients with incident HFpEF. METHODS: Retrospective study over 15 years on 3864 patients with HFpEF (GAMIC cohort)...
January 29, 2019: International Journal of Clinical Practice
Vinesh Appadurai, Jennifer Thoreau, Theresa Malpas, Mugur Nicolae
BACKGROUND: An improvement in life expectancy in patients suffering from adult congenital heart disease (ACHD) has corresponded with a rise in heart failure incidence within this group. An area that has not been addressed in ACHD heart failure guidelines has been the use of combined inhibition of angiotensin receptor-neprolysin pathways. This case series sought to demonstrate tolerability and 6-month outcome measures of sacubitril/valsartan use in ACHD patients with a severely impaired systemic ventricle...
December 17, 2018: Heart, Lung & Circulation
Yuliya Lytvyn, Lucas C Godoy, Rosalie A Scholtes, Daniël H van Raalte, David Z Cherney
PURPOSE OF REVIEW: Type 2 diabetes (T2D) is associated with an increased risk of diabetic kidney disease (DKD), cardiovascular disease, and heart failure, in part through activation of the renin-angiotensin-aldosterone system (RAAS). Although recent cardiovascular outcome trials have identified newer therapeutic agents such as sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1)-receptor agonists that reduce the risk of these complications, patients still exhibit residual cardiorenal morbidity and mortality...
January 23, 2019: Current Diabetes Reports
Martin Frigaard, Anna Rubinsky, Lo Lowell, Anna Malkina, Leah Karliner, Michael Kohn, Carmen A Peralta
BACKGROUND: Electronic health record (EHR) data is increasingly used to identify patients with chronic kidney disease (CKD). EHR queries used to capture CKD status, identify comorbid conditions, measure awareness by providers, and track adherence to guideline-concordant processes of care have not been validated. METHODS: We extracted EHR data for primary-care patients with two eGFRcreat 15-59 mL/min/1.73 m^2 at least 90 days apart. Two nephrologists manually reviewed a random sample of 50 charts to determine CKD status, associated comorbidities, and physician awareness of CKD...
January 3, 2019: BMC Nephrology
Jubran Boulos, Wisam Darawsha, Zaid A Abassi, Zaher S Azzam, Doron Aronson
AIMS: In the present study, we aimed to determine the relationship between therapeutic decisions during the treatment of acute heart failure (AHF) patients who develop acute kidney injury (AKI) and subsequent renal and clinical outcomes. METHODS AND RESULTS: We studied 277 patients with AHF and AKI, defined as an increase of >0.3 mg/dL in serum creatinine. The physician response to AKI was determined through a treatment composite score that captured changes in medical management in response to AKI, including a reduction (≥50%) or discontinuation of selected medication classes [angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-Is/ARBs), beta-blockers, and diuretics] and fluids administration...
December 19, 2018: ESC Heart Failure
A Fortini, V Verdiani, G Panigada, C Angotti, L Masotti
BACKGROUND: Guidelines recommend triple therapy (TT) with ACE inhibitors or ARBs, beta-blockers and mineralcorticoid receptor antagonists in symptomatic heart failure patients with ejection fraction <35 % (HFrEF). Nevertheless, many patients remain untreated. This study was aimed to evaluate the use of TT in HFrEF patients discharged from internal medicine wards of Tuscany, Italy. METHODS AND RESULTS: We analyzed the database of a multicenter observational study which included 770 patients consecutively hospitalized for HF in 32out of 36 Internal Medicine Units of Tuscany, Italy...
November 2018: La Clinica Terapeutica
Pieter Martens, Petra Nijst, Matthias Dupont, Wilfried Mullens
BACKGROUND: Progressive plasma volume (PV) expansion is a hallmark of chronic heart failure (HF), ultimately contributing to decompensated heart failure. Monitoring PV might offer prognostic information and might be a target for tailored therapy. METHODS: The correlation between technetium-(99 Tc)-labeled red blood cell measured PV and calculated PV was first determined in a validation cohort. The relationship between PV-status (PVS; a marker how much actual PV deviated from the ideal PV) and outcome was analyzed using cox-proportional modeling in a prospective CHF-population (the outcome cohort)...
December 4, 2018: Journal of Cardiac Failure
Kelsie E Oatmen, Michael R Zile, John C Burnett, Francis G Spinale
Importance: The standard pharmacotherapy for heart failure (HF), particularly HF with reduced ejection fraction (HFrEF), is primarily through the use of receptor antagonists, notably inhibition of the renin-angiotensin system by either angiotensin-converting enzyme inhibition or angiotensin II receptor blockade (ARB). However, the completed Prospective Comparison of ARNI With an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial identified that the use of a single molecule (sacubitril/valsartan), which is an ARB and the neutral endopeptidase inhibitor (NEPi) neprilysin, yielded improved clinical outcomes in HFrEF compared with angiotensin-converting enzyme inhibition alone...
November 28, 2018: JAMA Cardiology
Yu Jie Chen, Liang Jin Li, Wen Lu Tang, Jia Yang Song, Ru Qiu, Qian Li, Hao Xue, James M Wright
BACKGROUND: This is the first update of a Cochrane Review first published in 2015. Renin angiotensin system (RAS) inhibitors include angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and renin inhibitors. They are widely prescribed for treatment of hypertension, especially for people with diabetes because of postulated advantages for reducing diabetic nephropathy and cardiovascular morbidity and mortality. Despite widespread use for hypertension, the efficacy and safety of RAS inhibitors compared to other antihypertensive drug classes remains unclear...
November 14, 2018: Cochrane Database of Systematic Reviews
Kathir Balakumaran, Aadhar Patil, Shannon Marsh, Joseph Ingrassia, Chia-Ling Kuo, Daniel Louis Jacoby, Sabeena Arora, Richard Soucier
Introduction: Heart failure is associated with recurrent hospitalizations and high mortality. Guideline directed medical treatment (GDMT), including beta blockers (BBs), angiotensin converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs) and aldosterone antagonists (AAs) has shown to improve outcomes. Current guidelines recommend the use of these medication classes at maximally tolerated dosages. Despite the evidence, < 25% of patients with heart failure with reduced left ventricular ejection fraction (HFrEF) are on the appropriate medical regimen titrated to the target doses...
March 2019: IJC Heart & Vasculature
J Kuschyk, B Rudic, V Liebe, E Tülümen, M Borggrefe, I Akin
The worldwide prevalence of heart failure is 1-2% with a portion of >10% in patients older than 70 years. In addition to treatment of causal determined factors and lifestyle modification, basic treatment consists of guideline-directed medical therapy with angiotensin-converting enzyme inhibitors (ACE), β‑blockers (BB), mineralocorticoid receptor antagonists (MRA), diuretics, digitalis (class IIb recommendation), angiotensin receptor blockers (ARB), Iƒ-channel blockers plus recently recommended in the guidelines angiotensin receptor neprilysin inhibitor (ARNI) to substitute the ACE inhibitor (class I b)...
December 2018: Herzschrittmachertherapie & Elektrophysiologie
Nam-Kyoo Lim, Sang Eun Lee, Hae-Young Lee, Hyun-Jai Cho, Won-Seok Choe, Hokon Kim, Jin Oh Choi, Eun-Seok Jeon, Min-Seok Kim, Jae-Joong Kim, Kyung-Kuk Hwang, Shung Chull Chae, Sang Hong Baek, Seok-Min Kang, Dong-Ju Choi, Byung-Su Yoo, Kye Hun Kim, Myeong-Chan Cho, Byung-Hee Oh, Hyun-Young Park
BACKGROUND: Identifying patients with acute heart failure (HF) at high risk for readmission or death after hospital discharge will enable the optimization of treatment and management. The objective of this study was to develop a risk score for 30-day HF-specific readmission or death in Korea. METHODS: We analyzed the data from the Korean Acute Heart Failure (KorAHF) registry to develop a risk score. The model was derived from a multiple logistic regression analysis using a stepwise variable selection method...
October 22, 2018: Journal of Cardiology
Adam D DeVore, C Larry Hill, Laine Thomas, Puza P Sharma, Nancy M Albert, Javed Butler, J Herbert Patterson, John A Spertus, Fredonia B Williams, Carol I Duffy, Kevin McCague, Adrian F Hernandez, Gregg C Fonarow
Background Current guidelines recommend sacubitril/valsartan for patients with heart failure with reduced ejection fraction, but the rate of adoption in the United States has been slow. Methods and Results Using data from CHAMP-HF (Change the Management of Patients With Heart Failure), we described current sacubitril/valsartan use and identified patient, provider, and practice characteristics associated with its use. We considered patients to be on sacubitril/valsartan if they were prescribed it before enrollment or initiated on it at the baseline visit...
September 2018: Circulation. Heart Failure
Michael H Chiu, Robert J H Miller, Rebecca Barry, Bing Li, Bryan J Har, Stephen B Wilton, Merril Knudtson, Jonathan G Howlett, Matthew T James
Background: Angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACE-I/ARB) improve outcomes in patients with heart failure and reduced left-ventricular (LV) systolic function. However, these medications can cause a rise in serum creatinine and their benefits in patients with HF accompanied by kidney disease are less certain. Objective: To characterize associations between estimated glomerular filtration rate (eGFR), patterns of ACE-Is and ARBs use, and 1-year survival following hospitalization for heart failure (HF)...
2018: Canadian Journal of Kidney Health and Disease
Cherinne Arundel, Helen M Sheriff, Phillip H Lam, Selma F Mohammed, Linda G Jones, Corrine Y Jurgens, Charity J Morgan, Charles Faselis, Richard M Allman, Gregg C Fonarow, Ali Ahmed
BACKGROUND: Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-ARBs) improve outcomes in heart failure (HF). Less is known about this association in nursing home (NH) residents. METHODS: Of the 8024 hospitalized HF patients, 542 were NH residents, of whom 252 received ACEIs-ARBs. We assembled a propensity score-matched cohort of 157 pairs of NH residents receiving and not receiving ACEIs-ARBs balanced on 29 baseline characteristics (mean age, 3 years, 74% women, 17% African American), in which we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with ACEI-ARB use...
September 25, 2018: American Journal of Therapeutics
Pei-Yu Liu, Chien-Lin Chen, Min-Chien Yu, Yu-Lin Ko, Shun-Yi Hsu, Hsin-Hua Chou, Kuan-Hung Yeh, De-Min Duan, Ming-Hsin Chen, Jeng-Feng Lin
OBJECTIVES: In patients with ST-elevation myocardial infarction (STEMI), it is not clear whether low-dose renin-angiotensin system inhibitors and beta-blockers can result in the same benefits achievable with higher target doses. This observational study aims to investigate whether higher doses of angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) and beta-blockers can improve outcomes in patients with STEMI. METHODS: We recorded daily doses of ACEI, ARB, and beta-blockers in 331 patients with STEMI...
October 8, 2018: Acta Clinica Belgica
Tatsuya Morimoto, Masafumi Funamoto, Yoichi Sunagawa, Yasufumi Katanasaka, Yusuke Miyazaki, Koji Hasegawa
 Hemodynamic stresses, including hypertension and myocardial infarction, activate neurohumoral factors such as the sympathetic nervous system and the renin-angiotensin system, and can lead to the progression of heart failure. Established pharmacological agents such as angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, and β-blockers target extra-cellular molecules and receptors on the cell membrane. These agents have shown some efficacy for the treatment of heart failure, but the long-term survival rate of patients with heart failure remains low...
2018: Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan
Abigail Khan, Emmanuelle Paré, Shimoli Shah
PURPOSE OF REVIEW: This review summarizes the pathophysiology, diagnosis, and treatment of peripartum cardiomyopathy (PPCM), with a focus on recent discoveries of clinical relevance. RECENT FINDINGS: An increase in oxidative stress and anti-angiogenic activity play key roles in the pathophysiology of peripartum cardiomyopathy. Therapies that target this dysregulation may have a future role in treatment. Suppression of prolactin release using bromocriptine, a dopamine-receptor antagonist, has been associated with more favorable outcomes in small studies but more research is needed...
September 29, 2018: Current Treatment Options in Cardiovascular Medicine
Pedro J Tárraga López, M José Villar Inarejos, Ibrahim M Sadek, Fátima Madrona Marcos, Loreto Tárraga Marcos, Miguel Ángel Simón García
OBJECTIVE: To analyse the heart failure situation in a health area, as well quality criteria. METHOD: Cross-sectional observational study of patients diagnosed with heart failure by collecting data from their clinical history in the «Turriano» computer program. The variables analysed were, comorbidities, control of cardiovascular risk factors, treatments, number of chronic diseases, and admissions. The level of adherence to drugs in relation to heart failure by determining the ratio between the percentage of prescribed drugs and drugs withdrawn from pharmacy is also analysed using the Turriano prescription program...
September 24, 2018: Clínica e Investigación en Arteriosclerosis
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