Main Article Content
OBJECTIVES: To determine the prevalence and characteristics of patients who achieved target doses of angiotensin converting enzyme inhibitors (ACEIs)/ angiotensin II receptor blockers (ARBs), beta-blocker, and mineralocorticoid receptor antagonists (MRAs).
MATERIALS AND METHODS: A retrospective chart review study of heart failure with reduced ejection fraction (HFrEF) patients who received ACEIs/ARBs, beta-blockers, or MRAs and follow-up more than four times at the heart failure outpatient clinic, Chonburi hospital from February 1st, 2017 to February 29th, 2020. Patient data were retrieved from electronic medical records. Two authors collected data into record form (CRF) independently. Achieving target doses was defined by recommended doses according to the ACC/AHA/HFSA Guideline, 2017. The comparison of continuous data was conducted with the Mann-Whitney U test. Pearson Chi-Square and Fisher’s exact test were used for the comparison of categorical data.
RESULTS: Patients who achieved target doses of ACEIs/ARBs, beta-blockers and MRAs was 73.3%, 55.3%, and 7.1% respectively. Patients’ characteristics of achieved target doses of ACEIs/ARBs were higher baseline left ventricular ejection fractions (p = 0.026). Younger age (p = 0.016), body mass index (BMI) ≥ 23 kg/m2 (p = 0.037; OR 5.3) and serum creatinine ≤ 2 mg/dL (p = 0.004) were the characteristics of patients who achieved target doses of beta-blockers.
CONCLUSION: Most patients in heart failure clinic achieved target doses of ACEIs/ARBs followed by beta-blockers but only a few patients for MRAs. Patient and medical characteristics were different in target doses achievable.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lippi G, Sanchis-Gomar FJAMJ. Global epidemiology and future trends of heart failure. 2020. 2020;5.
Ponikowski P, Anker SD, AlHabib KF, Cowie MR, Force TL, Hu S, et al. Heart failure: preventing disease and death worldwide. 2014;1(1):4-25.
Moleerergpoom W, Hengrussamee K, Piyayotai D, Jintapakorn W, Sukhum P, Kunjara-Na-Ayudhya R, et al. Predictors of in-hospital mortality in acute decompensated heart failure (Thai ADHERE). J Med Assoc Thai. 2013;96(2):157-64.
Buakhamsri, editor Heart Failure Council of Thailand ( HFCT ) 2019 Heart Failure Guideline : Pharmacologic Treatment of Chronic Heart Failure-Part II2019.
Maddox TM, Januzzi JL, Jr., Allen LA, Breathett K, Butler J, Davis LL, et al. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021;77(6):772-810.
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. 2022;145(18):e895-e1032.
Anupraiwan อ, Innoi ยพ, Hengrussamee เย. Optimization of Medical Treatment in Heart Failure with Reduced Ejection Fraction and Clinical Outcomes in the New Era. Journal of The Department of Medical Services. 2022;46(4):81-90.
Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, et al. Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry. Journal of the American College of Cardiology. 2018;72(4):351-66.
Ouwerkerk W, Voors AA, Anker SD, Cleland JG, Dickstein K, Filippatos G, et al. Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study. Eur Heart J. 2017;38(24):1883-90.
Böhm M, Bewarder Y, Kindermann I, Slawik J, Wintrich J, Werner C. Optimization of Heart Failure Treatment by Heart Rate Reduction. International Journal of Heart Failure. 2019;2.
Pinho-Gomes AC, Rahimi K. Management of blood pressure in heart failure. 2019;105(8):589-95.
Greene SJ, Tan X, Yeh YC, Bernauer M, Zaidi O, Yang M, et al. Factors associated with non-use and sub-target dosing of medical therapy for heart failure with reduced ejection fraction. Heart Fail Rev. 2022;27(3):741-53.
Kukin ML, Mannino MM, Freudenberger RS, Kalman J, Buchholz-Varley C, Ocampo O. Hemodynamic comparison of twice daily metoprolol tartrate with once daily metoprolol succinate in congestive heart failure. Journal of the American College of Cardiology. 2000;35(1):45-50.
Delea TE, Stanford R, Hagiwara M, Edelsberg JS, Oster G. Death and hospitalization in heart failure patients receiving carvedilol vs. metoprolol tartrate. International Journal of Cardiology. 2005;99(1):117-24.
Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29(19):2388-442.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. 2017;136(6):e137-e61.
Greene SJ, Fonarow GC, DeVore AD, Sharma PP, Vaduganathan M, Albert NM, et al. Titration of Medical Therapy for Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol. 2019;73(19):2365-83.