Article (Scientific journals)
Drug Layering in Heart Failure: Phenotype-Guided Initiation.
Rosano, Giuseppe M C; Allen, Larry A; Abdin, Amr et al.
2021In JACC: Heart Failure, 9 (11), p. 775-783
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Keywords :
Pharmaceutical Preparations; Heart Failure/drug therapy; Humans; Phenotype; Prospective Studies; Stroke Volume; drugs; heart failure treatments; medical treatment; prognosis
Abstract :
[en] Medications with proven benefit in patients with heart failure with reduced ejection fraction are recommended, according to prospective large clinical trials, in the stable patient after careful up-titration in a strict sequential order. Although the relevance of careful clinical up-titration is unproven, there is evidence that after recompensation and shortly after hospital discharge, the rate of cardiovascular death and hospitalization is high. Clinical studies provided evidence that the onset of treatment effects is rapid, occurring within 28 days with most of these drugs used, and in some trials, early treatment after discharge or already started in the hospital has provided benefits. Therefore, early treatment without deferring it to the stable outpatient may be useful to reduce cardiac-related events further. This expert opinion proposes treatment layering according to individual patient phenotypes involving heart rate, blood pressure, impaired renal function, and electrolyte disturbances, as well as dedicated subgroups of patients with specific requirements for treatment initiation. This complements other approaches that suggest starting sequential treatment according to the size of treatment effects of drugs, specific cardiac diseases, and patient wishes. Patient phenotyping may guide personalized drug layering in heart failure with reduced ejection fraction that provides the best outcomes, whereas pragmatic clinical trials are warranted to scrutinize the effectiveness of these approaches.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Rosano, Giuseppe M C;  Centre for Clinical and Basic Research, IRCCS San Raffaele Roma, Rome, Italy.
Allen, Larry A;  Division of Cardiology, University of Colorado, School of Medicine, Aurora,
Abdin, Amr;  Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland
Lindenfeld, Joann;  Department of Medicine, Vanderbilt University Medical Center, Nashville,
O'Meara, Eileen;  Department of Cardiology, Montreal Heart Institute, Université de Montréal,
Lam, Carolyn S P;  Duke-National University of Singapore and National Heart Centre Singapore,
LANCELLOTTI, Patrizio  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie
Savarese, Gianluigi;  Division of Cardiology, Department of Medicine, Karolinska Institutet and Heart
Gottlieb, Stephen S;  University of Maryland School of Medicine and Baltimore Veterans Affairs Medical
Teerlink, John;  Section of Cardiology, San Francisco Veterans Affairs Medical Center, San
Wintrich, Jan;  Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland
Böhm, Michael;  Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland
Language :
English
Title :
Drug Layering in Heart Failure: Phenotype-Guided Initiation.
Publication date :
November 2021
Journal title :
JACC: Heart Failure
ISSN :
2213-1779
eISSN :
2213-1787
Publisher :
Elsevier
Volume :
9
Issue :
11
Pages :
775-783
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Available on ORBi :
since 24 May 2022

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