Title |
Optimisation of treatments for heart failure with reduced ejection fraction in routine practice: a position statement from a panel of experts
|
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Published in |
Revista Espanola De Cardiologia, March 2023
|
DOI | 10.1016/j.rec.2023.03.005 |
Pubmed ID | |
Authors |
Nicolas Girerd, Christophe Leclercq, Olivier Hanon, Antoni Bayés-Genís, James L Januzzi, Thibaut Damy, Benoit Lequeux, Christophe Meune, Pierre Sabouret, François Roubille |
Abstract |
Major international practice guidelines recommend the use of a combination of 4 medication classes in the treatment of patients with heart failure with reduced ejection fraction (HFrEF) but do not specify how these treatments should be introduced and up-titrated. Consequently, many patients with HFrEF do not receive an optimized treatment regimen. This review proposes a pragmatic algorithm for treatment optimization designed to be easily applied in routine practice. The first goal is to ensure that all 4 recommended medication classes are initiated as early as possible to establish effective therapy, even at a low dose. This is considered preferable to starting fewer medications at a maximum dose. The second goal is to ensure that the intervals between the introduction of different medications and between different titration steps are as short as possible to ensure patient safety. Specific proposals are made for older patients (> 75 years) who are frail, and for those with cardiac rhythm disorders. Application of this algorithm should allow an optimal treatment protocol to be achieved within 2-months in most patients, which should the treatment goal in HFrEF. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 64 | 24% |
United Kingdom | 16 | 6% |
Mexico | 10 | 4% |
France | 9 | 3% |
Spain | 9 | 3% |
India | 7 | 3% |
Canada | 6 | 2% |
Colombia | 4 | 1% |
Brazil | 4 | 1% |
Other | 46 | 17% |
Unknown | 92 | 34% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 174 | 65% |
Practitioners (doctors, other healthcare professionals) | 42 | 16% |
Scientists | 39 | 15% |
Science communicators (journalists, bloggers, editors) | 12 | 4% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 11 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 2 | 18% |
Professor | 1 | 9% |
Student > Bachelor | 1 | 9% |
Student > Postgraduate | 1 | 9% |
Unknown | 6 | 55% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 2 | 18% |
Pharmacology, Toxicology and Pharmaceutical Science | 1 | 9% |
Arts and Humanities | 1 | 9% |
Economics, Econometrics and Finance | 1 | 9% |
Business, Management and Accounting | 1 | 9% |
Other | 0 | 0% |
Unknown | 5 | 45% |