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• W4313444031 abstract "Heart failure (HF) patients are still undertreated due to a clinical inertia that needs to be reversed as soon as possible using new, safe and available methods. Remote up-titrating HF medication might be the solution to rapidly optimize HF treatment to maximal tolerated doses. Our objective was to describe the safety, efficacy, and feasibility of an ultra-fast remote up-titration protocol of HF treatment. Patients with a recent hospitalization due to a HF decompensation and left ventricular ejection fraction < 50% were retrospectively included in our database. Our protocol consisted in remote consultation (via telephone or video-consultation) every 15 days with a 72 h prior blood test. Blood pressure (BP), heart rate (HR) and weight were recorded. We evaluated 96 patients, 25% female with a mean LVEF at 29%, main etiology of HF was ischemic (48%) and mean NTproBNP was 2384 pg/mL. 94 patients were initially treated with a beta blocker (BB), 29% of our cohort was treated either with an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) and 59% was treated with angiotensin receptor neprilysin inhibitor (ARNI). A total of 72 patients were treated with a mineralocorticoid receptor antagonist (MRA) and 58 patients were also treated with an inhibitor of sodium-glucose transport protein 2 (SLGT2i), Fig. 1. Median duration of tele-titration consultation was 42 days. We up-titrated BB in 50% of our patients, of which 10% were at maximum dose, making a total of 98% of our cohort under BB treatment. Sixty percent of patients under ACEI or ARB were switched to ARNI. Of the 82% of patients under ARNI, up to 50% achieved the maximal dose. We introduced or up-titrated ARM in 41 patients, reaching the target dose in 37%. Dose variations and mean initial and final doses are shown in Fig. 2.1 and 2.2. Minor adverse events that motivated a down-titration or a cessation of treatment were, hyperkalemia 5%, acute renal failure (ARF) 6%, hypotension 3% and bradycardia 2%. Non urgent hospitalization due to ARF with hyperkalemia or HF only occured in 2 cases. Remote up-titration of HF medication is a promising tool in the fight against clinical inertia and a fast, feasible, safe (only 2% of major events) and efficient solution to our undertreated patients." @default.
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• W4313444031 date "2023-01-01" @default.
• W4313444031 modified "2023-09-26" @default.
• W4313444031 title "Ultra-fast remote up-titration of heart failure treatment: A safe, efficient, and feasible protocol" @default.
• W4313444031 doi "https://doi.org/10.1016/j.acvdsp.2022.10.079" @default.
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