A study published in JACC: Heart Failure found that many patients admitted to the hospital with acute heart failure (AHF) were eligible for HF agents from recent clinical trials.
Investigators from the University of British Columbia sourced data for this study from the CAN-HF (Canadian Heart Failure) registry, which was a retrospective, observational study. Between 2017 and 2020, patients (N=943) with AHF were enrolled in CAN-HF at 7 sites in Canada. For this study, patients (n=809) admitted with AHF with left ventricular ejection fraction (LVEF) data were evaluated for eligibility to receive guideline-directed comprehensive therapies. Heart failure with reduced ejection fraction (HFrEF) was defined as an LVEF of 40% or less and heart failure with preserved ejection fraction (HFpEF) as an LVEF of more than 40%. Eligibility was based on Canadian Cardiovascular Society (CCS) 2021, American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Failure Society of America (HFSA) 2022, and European Society of Cardiology (ESC) 2021 updated guidelines.
The patients with HFrEF (n=455) and HFpEF (n=354) had a mean age of 71.6 (SD, 15.3) and 79.3 (SD, 11.6) years (P <.001), 69.5% and 42.4% were men (P <.001), 38.2% and 47.2% had atrial fibrillation (P =.011), 49.0% and 39.3% had coronary artery disease (P =.006), and 29.7% and 20.1% had a previous HF hospitalization (P =.002), respectively. A total of 163 and 121 had de novo HF and 292 and 233 had chronic HF among the HFrEF and HFpEF groups, respectively.
Among the HFrEF cohort, 94.9% were eligible for β-blockers, 88.6% for sodium/glucose cotransporter 2 inhibitors (SGLT2is), 84.4% for mineralocorticoid receptor antagonists (MRAs), 80.7% for angiotensin-converting enzyme inhibitors (ACEis) or angiotensin-receptor blockers (ARBs), 73.6% for angiotensin receptor-neprilysin inhibitors (ARNIs), 37.6% for dapagliflozin, 35.4% for empagliflozin, 30.1% for omecamtiv mecarbil, 25.9% for vericiguat, 15.6% for ivabradine, and 11.9% for hydralazine or nitrate.
The eligibility rates among the HFpEF group included 83.1% for MRAs, 59.9% for SGLT2is, and 37.6% for ARNIs.
At discharge, 76.9% of patients with HFpEF who were eligible for MRA therapy were not discharged with a prescription. For the HFrEF cohort, among those eligible for each drug, 93.4% were not prescribed ARNIs, 56.0% were not prescribed MRAs, 37.9% were not prescribed ACEIs/ARBs, and 19.0% were not prescribed β-blockers.
The results of this study may not be generalizable for a more diverse group of patients.
“Among a large cohort of Canadian patients admitted to the hospital with HF decompensation, a significant proportion are eligible for initiation of disease-modifying pharmacotherapies for treatment of HFrEF and HFpEF,” wrote the researchers. “Our hope is that by presenting these data from a contemporary AHF population, we can set a framework for clinicians to consider early and rapid prescription of comprehensive HF therapies.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Moghaddam N, Hawkins NM, McKelvie R, et al. Patient eligibility for established and novel guideline-directed medical therapies after acute heart failure hospitalization. JACC Heart Fail. Published online January 11, 2023. doi:10.1016/j.jchf.2022.10.013