Optimizing heart failure treatment following cardiac resynchronization therapy

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Optimizing heart failure treatment following cardiac resynchronization therapy. / Jorsal, Anders; Pryds, Kasper; McMurray, John J V; Wiggers, Henrik; Sommer, Anders; Nielsen, Jens Cosedis; Nielsen, Roni Ranghøj.

In: Clinical Research in Cardiology, Vol. 109, No. 5, 05.2020, p. 638-645.

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Jorsal, Anders ; Pryds, Kasper ; McMurray, John J V ; Wiggers, Henrik ; Sommer, Anders ; Nielsen, Jens Cosedis ; Nielsen, Roni Ranghøj. / Optimizing heart failure treatment following cardiac resynchronization therapy. In: Clinical Research in Cardiology. 2020 ; Vol. 109, No. 5. pp. 638-645.

Bibtex

@article{38af98c88e4b4dbc9f30d59657b6b4e9,
title = "Optimizing heart failure treatment following cardiac resynchronization therapy",
abstract = "BACKGROUND: Device therapy in addition to medical treatment improves prognosis in a subset of patients with heart failure and reduced ejection fraction. However, some patients remain symptomatic or their heart failure even progresses despite cardiac resynchronization therapy (CRT). The aim of the study was to evaluate the proportion of patients who could benefit from optimization of medical therapy using sacubitril/valsartan, ivabradine, or both following CRT implantation.METHODS: We conducted a post hoc analysis of a single-centre, patient and outcome-assessor blinded, randomized-controlled trial, in which patients scheduled for CRT were randomized to empiric (n = 93) or imaging-guided left-ventricular lead placement (n = 89). All patients underwent clinical evaluation and blood sampling at baseline and 6 months following CRT implantation. The proportion of patients meeting the indication for sacubitril/valsartan (irrespective of angiotensin-converting enzyme inhibitor or angiotensin 2 receptor blocker dosage) and/or ivabradine according to current guidelines was evaluated at baseline and after 6 months.RESULTS: Of 182 patients with an indication for CRT, 146 (80%) also had an indication for optimization of medical therapy at baseline by adding sacubitril/valsartan, ivabradine, or both. Of the 179 survivors at 6 months, 136 (76%) were still symptomatic after device implantation; of these, 51 (38%) patients had an indication for optimization of medical therapy: sacubitril/valsartan in 37 (27%), ivabradine in 7 (5%), and both drugs in 7 (5%) patients. Seven (18%) patients without indication at baseline developed an indication for medical optimization 6 months after CRT implantation.CONCLUSION: In the present study, 38% of those who remained symptomatic 6 months after CRT implantation were eligible for optimization of medical therapy with sacubitril/valsartan, ivabradine, or both. Patients with CRT may benefit from systematic follow-up including evaluation of medical treatment.",
keywords = "Angiotensin receptor neprilysin inhibitor, Cardiac resynchronization therapy, Heart failure, Ivabradine",
author = "Anders Jorsal and Kasper Pryds and McMurray, {John J V} and Henrik Wiggers and Anders Sommer and Nielsen, {Jens Cosedis} and Nielsen, {Roni Rangh{\o}j}",
note = "https://doi.org/10.1007/s00392-019-01553-4 ",
year = "2020",
month = may,
doi = "10.1007/s00392-019-01553-4",
language = "English",
volume = "109",
pages = "638--645",
journal = "Clinical Research in Cardiology",
issn = "1861-0684",
publisher = "Springer Medizin",
number = "5",

}

RIS

TY - JOUR

T1 - Optimizing heart failure treatment following cardiac resynchronization therapy

AU - Jorsal, Anders

AU - Pryds, Kasper

AU - McMurray, John J V

AU - Wiggers, Henrik

AU - Sommer, Anders

AU - Nielsen, Jens Cosedis

AU - Nielsen, Roni Ranghøj

N1 - https://doi.org/10.1007/s00392-019-01553-4

PY - 2020/5

Y1 - 2020/5

N2 - BACKGROUND: Device therapy in addition to medical treatment improves prognosis in a subset of patients with heart failure and reduced ejection fraction. However, some patients remain symptomatic or their heart failure even progresses despite cardiac resynchronization therapy (CRT). The aim of the study was to evaluate the proportion of patients who could benefit from optimization of medical therapy using sacubitril/valsartan, ivabradine, or both following CRT implantation.METHODS: We conducted a post hoc analysis of a single-centre, patient and outcome-assessor blinded, randomized-controlled trial, in which patients scheduled for CRT were randomized to empiric (n = 93) or imaging-guided left-ventricular lead placement (n = 89). All patients underwent clinical evaluation and blood sampling at baseline and 6 months following CRT implantation. The proportion of patients meeting the indication for sacubitril/valsartan (irrespective of angiotensin-converting enzyme inhibitor or angiotensin 2 receptor blocker dosage) and/or ivabradine according to current guidelines was evaluated at baseline and after 6 months.RESULTS: Of 182 patients with an indication for CRT, 146 (80%) also had an indication for optimization of medical therapy at baseline by adding sacubitril/valsartan, ivabradine, or both. Of the 179 survivors at 6 months, 136 (76%) were still symptomatic after device implantation; of these, 51 (38%) patients had an indication for optimization of medical therapy: sacubitril/valsartan in 37 (27%), ivabradine in 7 (5%), and both drugs in 7 (5%) patients. Seven (18%) patients without indication at baseline developed an indication for medical optimization 6 months after CRT implantation.CONCLUSION: In the present study, 38% of those who remained symptomatic 6 months after CRT implantation were eligible for optimization of medical therapy with sacubitril/valsartan, ivabradine, or both. Patients with CRT may benefit from systematic follow-up including evaluation of medical treatment.

AB - BACKGROUND: Device therapy in addition to medical treatment improves prognosis in a subset of patients with heart failure and reduced ejection fraction. However, some patients remain symptomatic or their heart failure even progresses despite cardiac resynchronization therapy (CRT). The aim of the study was to evaluate the proportion of patients who could benefit from optimization of medical therapy using sacubitril/valsartan, ivabradine, or both following CRT implantation.METHODS: We conducted a post hoc analysis of a single-centre, patient and outcome-assessor blinded, randomized-controlled trial, in which patients scheduled for CRT were randomized to empiric (n = 93) or imaging-guided left-ventricular lead placement (n = 89). All patients underwent clinical evaluation and blood sampling at baseline and 6 months following CRT implantation. The proportion of patients meeting the indication for sacubitril/valsartan (irrespective of angiotensin-converting enzyme inhibitor or angiotensin 2 receptor blocker dosage) and/or ivabradine according to current guidelines was evaluated at baseline and after 6 months.RESULTS: Of 182 patients with an indication for CRT, 146 (80%) also had an indication for optimization of medical therapy at baseline by adding sacubitril/valsartan, ivabradine, or both. Of the 179 survivors at 6 months, 136 (76%) were still symptomatic after device implantation; of these, 51 (38%) patients had an indication for optimization of medical therapy: sacubitril/valsartan in 37 (27%), ivabradine in 7 (5%), and both drugs in 7 (5%) patients. Seven (18%) patients without indication at baseline developed an indication for medical optimization 6 months after CRT implantation.CONCLUSION: In the present study, 38% of those who remained symptomatic 6 months after CRT implantation were eligible for optimization of medical therapy with sacubitril/valsartan, ivabradine, or both. Patients with CRT may benefit from systematic follow-up including evaluation of medical treatment.

KW - Angiotensin receptor neprilysin inhibitor

KW - Cardiac resynchronization therapy

KW - Heart failure

KW - Ivabradine

U2 - 10.1007/s00392-019-01553-4

DO - 10.1007/s00392-019-01553-4

M3 - Journal article

C2 - 31559483

VL - 109

SP - 638

EP - 645

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

SN - 1861-0684

IS - 5

ER -