What is a cost-effective GDMT strategy for HFmrEF/HFpEF?

We built a model w/ clinical trial data (TOPCAT, PARAGON-HF, EMPEROR/DELIVER) and simulated outcomes w/ regimens of MRA/SGLT2i/ARNi.

Best 💊 combo?
MRA + SGLT2i

ARNi ⬇️ value at current 💵

Treat HF with urgency!

85 yoF persistent/refractory afib, HFmrEF, s/p biv PM with sob/oedema. Admitted for AVN ablation (examined just after this). AKI (SCr 1.5 —> 2.6). On 3L NC, bp 120/70, cool peripheries. Normal mental status.

⚠️そのβ遮断薬、害になっていませんか？📝

・米国でのレジストリ研究(2013-2017)
・EF40%以上の心不全患者におけるβ遮断薬の効果を検討

☑️HFmrEF→心不全入院,死亡のリスク↓
✅HFpEF→心不全入院リスクの増加と関連

βBで運動耐容能の低下が示唆される場合は、医師とディスカッションしてみましょう

#ESC2023 #ESCCongress 🇳🇱

👉dapa/empaGLIFLOZIN in HFpEF/HFmrEF (IA) in CKD and T2DM (IA)
👉finerenone in CKD and T2DM (IA)
👉rapid up-titration of treatment before discharge and at FU visits during first 6 weeks
👉iron IV in symptomatic HFrEF/HFmrEF and iron deficiency (IA)

Cost-Effectiveness of Medical Therapy for Heart Failure With Mildly Reduced and Preserved Ejection Fraction

For patients with heart failure, MRA was of high value, SGLT2i was of intermediate value, and ARNI was of low value in both HFmrEF and HFpEF

jacc.org/doi/10.1016/j.…

HFpEF vs HFmrEF management 🏥 via #ESC2023

🔑 Clinical Trials:

🔹DELIVER (2022) and EMPEROR-Preserved (2021): SGLT2i in EF>40%
🔹PARAGON-HF (2019): ARNI vs ARB in EF>45%
🔹TOPCAT (2014): MRA in EF>45%
🔹CHARM-Preserved (2003): ARB in EF>40%

📱App link: apps.apple.com/us/app/cardiac…

Beta-Blocker & Heart Failure Outcomes in HFmrEF and HFpEF
The PINNACLE data:

🔹435,897 Pts with HF and EF ≥40%
🔹 interactions between EF × beta-blocker use for HF hospitalization, death, and composite of HF hospitalization/death
🔹 Beta-blockers ⤵️ risk of HF hospitalization

Optimisation of treatments for heart failure with reduced ejection fraction in routine practice: a position statement from a panel of experts
sciencedirect.com/science/articl…
#REC #Cardiotwitter #cardiology #CardioEd #HFREF #HFpEF #hfmref

🔴 Both HFpEF and HFmrEF Should be Included in Calculating CHA2DS2–VASc score: a Longitudinal Cohort

👉HFpEF & HFmrEF showed a similar risk of stroke in AF pts.
👉Important to extend the criteria for 'C' in the CHA2DS2–VASc score to include HFpEF pts.
heartrhythmjournal.com/article/S1547-…

The non-PFA LBCT session
#HRS2024
CRT for HFmrEF
Surrogate PEP LVESV ⬇️

Pharmacological Treatments in #HF mrEF & #HF pEF : Systematic Review & Network Meta-Analysis
👉A quadruple combination of ARNI, BB, MRA, & SGLT2i had the greatest estimated aggregate benefit in #HF pts with LVEF of greater than 40%.
sciencedirect.com/science/articl…
#CardioTwitter #cardioEd

#BetaBlocker use in #HFpEF and #HFmrEF ❓

In this month’s issue of #JACCHF , analysis of #DELIVER trial shows:

♥️ 4 out of 5 px were treated with #BB
♥️ #BB use wasn't linked to #worseningHF or #CVdeath
♥️Benefits of #Dapagliflozin remained consistent regardless of #BB
➡️➡️

HFrEF/HFmrEFのGDMTスコアリング

✅急性非代償性心不全患者(HFrEF/HFmrEF)を対象
✅画像のスコアリングを実施
✅'5点以上'は全死亡、心不全再入院、複合アウトカム(全死亡＆心不全再入院)を有意に改善

pubmed.ncbi.nlm.nih.gov/37671603/

Beta-Blockers in HFmrEF or HFpEF | DELIVER trial:

•DELIVER trial: examined beta-blocker use in 6,263 HF patients
•83% used beta-blockers; associated with ⬇️ risk of cardiovascular death or worsening HF
•Dapagliflozin consistently reduced risk, regardless of beta-blocker use

SGLT2i, the new Class I drugs por HFmrEF and HFpEF, new ESC HF Guidelines 2023

🔴 Contemporary Use & Implications of Beta-Blockers in Ptsw/ HFmrEF or HFpEF: The DELIVER Trial

✅BB use wasn't linked to #worseningHF or #cvDeath . Benefits of #dapa remained regardless of BBs, reassuring their role in Rx HFpEF/ HFmrEF alongside #SGLT2i . bit.ly/4b2jQCQ

【慢性心不全】

HFmrEF
HFrecEF
HFimpEF

色々あって覚えられにゃい(ФωФ)

#循環器のトビラ
#不器用なまとめノート
#みなみの備忘録

🥇First randomized patient in Europe in the #ALLAYHF prospective, multicenter, sham-controlled trial to assess the safety and efficacy of a percutaneously created intraatrial shunt in patients with #HFpEF / #HFmrEF

Tobias Schmidt Alleviant Medical Young DGK AGIK Holger Thiele

📝 学生さんに知ってほしいEFの分類（まずは3つ）

▶️ HFrEF（心不全 with reduced EF）
→ EF≦40％（へふれふ）

▶️ HFpEF（心不全 with preserved EF）
→ EF≧50%（へふぺふ）

▶️ HFmrEF（心不全 with mildly reduced EF）
→ EF:41〜49%
（昔は「ミッドレンジ」って呼んでました、今は？🤔）

🔴 Contemporary Use & Implications of Beta-Blockers in Patients With HFmrEF or HFpEF: The DELIVER Trial JACC Journals #openaccess

🔴Beta-Blockers in HFpEF: Finding a Role, Easy…Finding the Evidence, Not So Much #editorial
👉jacc.org/doi/10.1016/j.…
👉jacc.org/doi/10.1016/j.…