Böhm, Michael;
Tschöpe, Carsten;
Wirtz, Jost Henner;
Lokies, Jan;
Turgonyi, Eva;
Bramlage, Peter;
Lins, Katharina;
Strunz, Anke M.;
Tebbe, Ulrich
Treatment of Heart Failure in Real‐World Clinical Practice: Findings From the REFLECT‐HF Registry in Patients With NYHA Class II Symptoms and a Reduced Ejection Fraction
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Medientyp:
E-Artikel
Titel:
Treatment of Heart Failure in Real‐World Clinical Practice: Findings From the REFLECT‐HF Registry in Patients With NYHA Class II Symptoms and a Reduced Ejection Fraction
Beschreibung:
<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Optimal medical therapy (<jats:styled-content style="fixed-case">OMT</jats:styled-content>) for patients with chronic heart failure and a reduced ejection fraction (<jats:styled-content style="fixed-case">HF‐REF</jats:styled-content>) includes angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, β‐blockers, and mineralocorticoid receptor antagonists, plus a diuretic.</jats:p></jats:sec><jats:sec><jats:title>Hypothesis</jats:title><jats:p>We hypothesized that <jats:styled-content style="fixed-case">OMT</jats:styled-content> is less often prescribed in <jats:styled-content style="fixed-case">HF‐REF</jats:styled-content> patients (≤35%) with New York Heart Association (<jats:styled-content style="fixed-case">NYHA</jats:styled-content>) class <jats:styled-content style="fixed-case">II</jats:styled-content> symptoms compared with those with <jats:styled-content style="fixed-case">NYHA</jats:styled-content> class <jats:styled-content style="fixed-case">III</jats:styled-content>/<jats:styled-content style="fixed-case">IV</jats:styled-content> symptoms.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This was a cross‐sectional, observational, multicenter survey of hospital‐based cardiologists, office‐based cardiologists, and general practitioners in Germany.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Out of a total of 384 patients enrolled, 144 had <jats:styled-content style="fixed-case">REF</jats:styled-content> ≤35%. Patients with <jats:styled-content style="fixed-case">REF</jats:styled-content> had <jats:styled-content style="fixed-case">NYHA</jats:styled-content> class <jats:styled-content style="fixed-case">II</jats:styled-content> symptoms in 39.6% (n = 57) and <jats:styled-content style="fixed-case">NYHA</jats:styled-content> class <jats:styled-content style="fixed-case">III</jats:styled-content>/<jats:styled-content style="fixed-case">IV</jats:styled-content> symptoms in 60.4% (n = 87). The <jats:styled-content style="fixed-case">REF</jats:styled-content>/<jats:styled-content style="fixed-case">NYHA</jats:styled-content> class <jats:styled-content style="fixed-case">II</jats:styled-content> group had a higher proportion of males than the <jats:styled-content style="fixed-case">REF</jats:styled-content>/<jats:styled-content style="fixed-case">NYHA</jats:styled-content> class <jats:styled-content style="fixed-case">III</jats:styled-content>/<jats:styled-content style="fixed-case">IV</jats:styled-content> group. For angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers and β‐blockers, prescription rates were high and comparable between groups. However, prescription rates for mineralocorticoid receptor antagonists were lower compared with other guideline‐recommended treatments. Multivariate analyses indicated that <jats:styled-content style="fixed-case">OMT</jats:styled-content> prescription was reduced for older patients and increased for patients cared for by an office‐based cardiologist.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Given the high proportion of patients with reduced left ventricular systolic function but only minor symptoms, <jats:styled-content style="fixed-case">HF‐REF</jats:styled-content> appears to be underdiagnosed, and a higher proportion of patients than are currently recognized could potentially be candidates for <jats:styled-content style="fixed-case">OMT</jats:styled-content>.</jats:p></jats:sec>