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Optimization of guideline-directed medical treatment for heart failure patients with reduced ejection fraction

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초록

With the increasing number of medications demonstrating mortality benefits in heart failure with reduced ejection fraction (HFrEF), the pharmacological treatment of HFrEF is entering a new phase. To enhance outcomes in heart failure patients through medical treatment, the choice of appropriate medications and simultaneous and rapid uptitration are critical. However, there are several challenges encountered during this medication uptitration, including issues like hypotension, fatigue, worsening renal function, and hyperkalemia. This paper addresses strategies for effectively managing these challenges to successfully reach the maximum tolerated dose in patients. Additionally, it will discuss the management of comorbidities often associated with heart failure, the importance of exercise and rehabilitation, and the significance of proper nutrition intake, in addition to guideline-directed medical therapy.

Abstract

With the increasing number of medications demonstrating mortality benefits in heart failure with reduced ejection fraction (HFrEF), the pharmacological treatment of HFrEF is entering a new phase. To enhance outcomes in heart failure patients through medical treatment, the choice of appropriate medications and simultaneous and rapid uptitration are critical. However, there are several challenges encountered during this medication uptitration, including issues like hypotension, fatigue, worsening renal function, and hyperkalemia. This paper addresses strategies for effectively managing these challenges to successfully reach the maximum tolerated dose in patients. Additionally, it will discuss the management of comorbidities often associated with heart failure, the importance of exercise and rehabilitation, and the significance of proper nutrition intake, in addition to guideline-directed medical therapy.

참고문헌 (86)

  1. Park Jin Joo, "Heart Failure Statistics in Korea, 2020: A Report from the Korean Society of Heart Failure", International Journal of Heart Failure, 3(4), pp.224~ (2021), 대한심부전학회[DOI]
  2. 최홍미, "Update on heart failure management and future directions", The Korean Journal of Internal Medicine, 34(1), pp.11~43 (2019), 대한내과학회[DOI]
  3. Jin Joo Park, "Current status of heart failure: global and Korea", The Korean Journal of Internal Medicine, 35(3), pp.487~497 (2020), 대한내과학회[DOI]
  4. Jung Mi-Hyang, "A Practical Way to Reduce Healthcare Costs in Patients With Heart Failure: Outpatient IV Diuretics Therapy", International Journal of Heart Failure, 4(1), pp.24~ (2022), 대한심부전학회[DOI]
  5. Heidenreich PA, "2022 AHA", ACC, American Heart Association Joint Committee on Clinical Practice Guidelines, pp.J Am Coll Cardiol, 2022[DOI]
  6. McDonagh TA, "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure", Eur Heart J, 42, pp.3599~3726 (2021)
  7. Jae Yeong Cho, "Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Definition and Diagnosis", Korean Circulation Journal, 53(4), pp.195~216 (2023), 대한심장학회[DOI]
  8. Solomon SD, "Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction", Eur Heart J, 37, pp.455~462 (2016)
  9. Solomon SD, "Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction", N Engl J Med, 381, pp.1609~1620 (2019)
  10. Lund LH, "Heart failure with mid-range ejection fraction in CHARM : characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum", Eur J Heart Fail, 20, pp.1230~1239 (2018)
  11. Lam CSP, "DELIVERing therapeutic efficacy across the ejection fraction spectrum of heart failure", Circulation, 146, pp.1193~1195 (2022)
  12. Bhosale KH, "Rate of rehospitalization in 60 days of discharge and it’s determinants in patients with heart failure with reduced ejection fraction in a tertiary care centre in India", Int J Heart Fail, 2, pp.131~144 (2020)
  13. Shah KS, "Heart failure with preserved, borderline, and reduced ejection fraction : 5-year outcomes", J Am Coll Cardiol, 70, pp.2476~2486 (2017)
  14. McMurray JJ, "Angiotensin-neprilysin inhibition versus enalapril in heart failure", N Engl J Med, 371, pp.993~1004 (2014)
  15. Lee HY, "Paradigm shifts of heart failure therapy : do we need another paradigm?", Int J Heart Fail, 2, pp.145~156 (2020)
  16. Hong-Mi Choi, "Angiotensin receptor-neprilysin inhibitor for the treatment of heart failure: a review of recent evidence", The Korean Journal of Internal Medicine, 35(3), pp.498~513 (2020), 대한내과학회[DOI]
  17. Kerr Brian, "Angiotensin Receptor Neprilysin Inhibitors in HFrEF: Is This the First Disease Modifying Therapy Drug Class Leading to a Substantial Reduction in Diuretic Need?", International Journal of Heart Failure, 3(2), pp.106~ (2021), 대한심부전학회[DOI]
  18. Talha Khawaja M., "SGLT-2 Inhibitors in Heart Failure: A Review of Current Evidence", International Journal of Heart Failure, 5(2), pp.82~90 (2023), 대한심부전학회[DOI]
  19. Youn Jong-Chan, "Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment", International Journal of Heart Failure, 5(2), pp.66~81 (2023), 대한심부전학회[DOI]
  20. Packer M, "Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group", Circulation, 100, pp.2312~2318 (1999)
  21. Konstam MA, "HEAAL Investigators. Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial", Lancet, 374, pp.1840~1848 (2009)
  22. Bristow MR, "Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators", Circulation, 94, pp.2807~2816 (1996)
  23. ), "Am J Cardiol", 1996, 902~907
  24. Mebazaa A, "Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure(STRONG-HF) : a multinational, open-label, randomised, trial", Lancet, 400, pp.1938~1952 (2022)
  25. Willenheimer R, "Effect on survival and hospitalization of initiating treatment for chronic heart failure with bisoprolol followed by enalapril, as compared with the opposite sequence: results of the randomized Cardiac Insufficiency Bisoprolol Study (CIBIS)III", Circulation, 112, pp.2426~2435 (2005)
  26. Se-Eun Kim, "Treatment Strategies of Improving Quality of Care in Patients With Heart Failure", Korean Circulation Journal, 53(5), pp.294~312 (2023), 대한심장학회[DOI]
  27. Greene SJ, "Medical therapy for heart failure with reduced ejection fraction : the CHAMP-HF registry", J Am Coll Cardiol, 72, pp.351~366 (2018)
  28. Park Jin Joo, "Real-World Usage of Sacubitril", Valsartan in Korea: A Multi-Center, Retrospective Study, 2022, pp.4(4), 193~[DOI]
  29. Peri-Okonny PA, "Target doses of heart failure medical therapy and blood pressure : insights from the CHAMP-HF registry", JACC Heart Fail, 7, pp.350~358 (2019)
  30. "Angiotensin-neprilysin inhibition in acute decompensated heart failure", N Engl J Med, 380, pp.1090~ (2019)
  31. Sanam K, "Renin-angiotensin system inhibition and lower 30-day all-cause readmission in medicare beneficiaries with heart failure", Am J Med, 129, pp.1067~1073 (2016)
  32. Tomasoni D, "Sodium-glucose co-transporter 2 inhibitors as an early, first-line therapy in patients with heart failure and reduced ejection fraction", Eur J Heart Fail, 24, pp.431~441 (2022)
  33. Helsi Rismiati, "The role of discharge checklist in guideline-directed medical therapy for heart failure patients", The Korean Journal of Internal Medicine, 38(2), pp.195~206 (2023), 대한내과학회[DOI]
  34. Kim JJ, "Eligibility and usage of sacubitril", valsartan in Korea, 2019, pp.1, 69~71
  35. Oh J, "Real-world eligibility for sacubitril", valsartan in heart failure with reduced ejection fraction patients in Korea : data from the Korean Acute Heart Failure(KorAHF)registry, 2019, pp.1, 57~68
  36. Marti CN, "Medication dosing for heart failure with reduced ejection fraction-opportunities and challenges", Eur J Heart Fail, 21, pp.286~296 (2019)
  37. Rosano GMC, "Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology", Eur J Heart Fail, 23, pp.872~881 (2021)
  38. Böhm M, "Optimization of heart failure treatment by heart rate reduction", Int J Heart Fail, 2, pp.1~11 (2019)
  39. Hesse K, "Target heart rate in heart failure with reduced ejection fraction and atrial fibrillation : Goldilocks zone", Am Heart J Plus Cardiol Res Pract, 23, pp.100218~ (2022)
  40. Hyun-Jin Kim, "The effect of beta-blockers in acute heart failure according to heart rate", The Korean Journal of Internal Medicine, 36(4), pp.898~905 (2021), 대한내과학회[DOI]
  41. Heusch G, "Heart rate in the pathophysiology of coronary blood flow and myocardial ischaemia : benefit from selective bradycardic agents", Br J Pharmacol, 153, pp.1589~1601 (2008)
  42. Volterrani M, "Effect of Carvedilol, Ivabradine or their combination on exercise capacity in patients with Heart Failure(the CARVIVA HF trial)", Int J Cardiol, 151, pp.218~224 (2011)
  43. Damman K, "The kidney in heart failure : an update", Eur Heart J, 36, pp.1437~1444 (2015)
  44. Youn Jong-Chan, "A Noteworthy Way to Predict Acute Decompensated Heart Failure in Patients With End-Stage Renal Disease", International Journal of Heart Failure, 4(3), pp.142~ (2022), 대한심부전학회[DOI]
  45. Kim Bong-Joon, "Increased Right Ventricular Pressure as a Predictor of Acute Decompensated Heart Failure in End-Stage Renal Disease Patients on Maintenance Hemodialysis", International Journal of Heart Failure, 4(3), pp.154~ (2022), 대한심부전학회[DOI]
  46. Damman K, "Progression of renal impairment and chronic kidney disease in chronic heart failure : an analysis from GISSI-HF", J Card Fail, 23, pp.2~9 (2017)
  47. Clark H, "Worsening renal function during renin-angiotensin-aldosterone system inhibitor initiation and long-term outcomes in patients with left ventricular systolic dysfunction", Eur J Heart Fail, 16, pp.41~48 (2014)
  48. Jang Se Yong, "Prognostic and Therapeutic Implications of Renal Insufficiency in Heart Failure", International Journal of Heart Failure, 4(2), pp.75~ (2022), 대한심부전학회[DOI]
  49. Mullens W, "Renal effects of guideline-directed medical therapies in heart failure : a consensus document from the Heart Failure Association of the European Society of Cardiology", Eur J Heart Fail, 24, pp.603~619 (2022)
  50. Kato ET, "Sodium-glucose co-transporters-2 inhibitors and heart failure : state of the art review and future potentials", Int J Heart Fail, 2, pp.12~22 (2020)
  51. Verma S, "Emerging role for SGLT2 inhibitors in mitigating the risk of hyperkalaemia in heart failure", Eur Heart J, 43, pp.2994~2996 (2022)
  52. Mc Causland FR, "Angiotensinneprilysin inhibition and renal outcomes in heart failure with preserved ejection fraction", Circulation, 142, pp.1236~1245 (2020)
  53. Lee S, "Sacubitril", valsartan in patients with heart failure with reduced ejection fraction with end-stage of renal disease, 2020, pp.7, 1125~1129
  54. Badve SV, "Effects of beta-adrenergic antagonists in patients with chronic kidney disease : a systematic review and meta-analysis", J Am Coll Cardiol, 58, pp.1152~1161 (2011)
  55. Cice G, "Carvedilol increases twoyear survivalin dialysis patients with dilated cardiomyopathy : a prospective, placebo-controlled trial", J Am Coll Cardiol, 41, pp.1438~1444 (2003)
  56. Butler J, "Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction : the DIAMOND trial", Eur Heart J, 43, pp.4362~4373 (2022)
  57. Kim D, "Untangling amyloidosis : recent advances in cardiac amyloidosis", Int J Heart Fail, 2, pp.231~239 (2020)
  58. Ammirati E, "Pharmacological treatment of hypertrophic cardiomyopathy : current practice and novel perspectives", Eur J Heart Fail, 18, pp.1106~1118 (2016)
  59. 박예민, "Updated risk assessments for sudden cardiac death in hypertrophic cardiomyopathy patients with implantable cardioverter-defibrillator", The Korean Journal of Internal Medicine, 38(1), pp.7~15 (2023), 대한내과학회[DOI]
  60. Hyun-Jung Lee, "Major Clinical Issues in Hypertrophic Cardiomyopathy", Korean Circulation Journal, 52(8), pp.563~575 (2022), 대한심장학회[DOI]
  61. Voors AA, "The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure : a multinational randomized trial", Nat Med, 28, pp.568~574 (2022)
  62. Takagi K, "Management of acute heart failure during an early phase", Int J Heart Fail, 2, pp.91~110 (2020)
  63. Ponikowski P, "Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial", Lancet, 396, pp.1895~1904 (2020)
  64. 김민철, "Pre-discharge anemia as a predictor of adverse clinical outcomes in patients with acute decompensated heart failure", The Korean Journal of Internal Medicine, 34(3), pp.549~558 (2019), 대한내과학회[DOI]
  65. Lewis GD, "Oral iron therapy for heart failure with reduced ejection fraction : design and rationale for oral iron repletion effects on oxygen uptake in heart failure", Circ Heart Fail, 9, pp.e000345~ (2016)
  66. Ferreira JP, "Impact of anaemia and the effect of empagliflozin in heart failure with reduced ejection fraction : findings from EMPEROR-Reduced", Eur J Heart Fail, 24, pp.708~715 (2022)
  67. 이규선, "Evaluation and Management of Patients with Diabetes and Heart Failure: A Korean Diabetes Association and Korean Society of Heart Failure Consensus Statement", Diabetes and Metabolism Journal, 47(1), pp.10~26 (2023), 대한당뇨병학회[DOI]
  68. Lind M, "Glycaemic control and incidence of heart failure in 20, 985 patients with type 1 diabetes : an observational study", Lancet, 378, pp.140~146 (2011)
  69. Giugliano D, "GLP-1 receptor agonists and cardiorenal outcomes in type 2 diabetes : an updated meta-analysis of eight CVOTs", Cardiovasc Diabetol, 20, pp.189~ (2021)
  70. Margulies KB, "NHLBI Heart Failure Clinical Research Network. Effects of liraglutide on clinical stability among patients with advanced heart failure and reduced ejection fraction: a randomized clinical trial", JAMA, 316, pp.500~508 (2016)
  71. Jorsal A, "Effect of liraglutide, a glucagon-like peptide-1 analogue, on left ventricular function in stable chronic heart failure patients with and without diabetes(LIVE)-a multicentre, double-blind, randomised, placebo-controlled trial", Eur J Heart Fail, 19, pp.69~77 (2017)
  72. Seferović PM, "European Society of Cardiology", Heart Failure Association position paper on the role and safety of new glucose-lowering drugs in patients with heart failure, 2020, pp.22, 196~213
  73. Gangu Karthik, "In-Hospital Mortality Rate and Predictors of 30-Day Readmission in Patients With Heart Failure Exacerbation and Atrial Fibrillation: A Cross-Sectional Study", International Journal of Heart Failure, 4(3), pp.145~ (2022), 대한심부전학회[DOI]
  74. Kim Yun Gi, "Interaction Between Heart Failure and Atrial Fibrillation", International Journal of Heart Failure, 4(3), pp.139~ (2022), 대한심부전학회[DOI]
  75. Kim Hee-Dong, "Left Atrial Dysfunction, Fibrosis and the Risk of Thromboembolism in Patients With Paroxysmal and Persistent Atrial Fibrillation", International Journal of Heart Failure, 4(1), pp.42~ (2022), 대한심부전학회[DOI]
  76. Daehoon Kim, "Optimal Rhythm Control Strategy in Patients With Atrial Fibrillation", Korean Circulation Journal, 52(7), pp.496~512 (2022), 대한심장학회[DOI]
  77. Banerjee A, "Ejection fraction and outcomes in patients with atrial fibrillation and heart failure : the Loire Valley Atrial Fibrillation Project", Eur J Heart Fail, 14, pp.295~301 (2012)
  78. Chung Hyemoon, "Left Atrial Remodeling and Thromboembolic Risk in Patients With Atrial Fibrillation", International Journal of Heart Failure, 4(1), pp.26~ (2022), 대한심부전학회[DOI]
  79. Carlisle MA, "Heart failure and atrial fibrillation, like fire and fury", JACC Heart Fail, 7, pp.447~456 (2019)
  80. Colin-Ramirez E, "Sodium restriction in patients with heart failure : a systematic review and meta-analysis of randomized clinical trials", Circ Heart Fail, 16, pp.e009879~ (2023)
  81. Camafort Miguel, "Lifestyle Modification in Heart Failure Management: Are We Using Evidence-Based Recommendations in Real World Practice?", International Journal of Heart Failure, 5(1), pp.21~33 (2023), 대한심부전학회[DOI]
  82. Alejandra García-García, "Is there sufficient evidence to justify changes in dietary habits in heart failure patients? A systematic review", The Korean Journal of Internal Medicine, 37(1), pp.37~47 (2022), 대한내과학회[DOI]
  83. Reilly CM, "Isolating the benefits of fluid restriction in patients with heart failure : a pilot study", Eur J Cardiovasc Nurs, 14, pp.495~505 (2015)
  84. Herrmann JJ, "Fluid REStriction in heart failure vs liberal fluid UPtake : rationale and design of the randomized FRESH-UP study", J Card Fail, 28, pp.1522~1530 (2022)
  85. Chun KH, "Cardiac rehabilitation in heart failure", Int J Heart Fail, 3, pp.1~14 (2020)
  86. Kensuke Ueno, "Effectiveness and Approach of Rehabilitation in Patients With Acute Heart Failure: A Review", Korean Circulation Journal, 52(8), pp.576~592 (2022), 대한심장학회[DOI]

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