| Title: |
Optimisation of treatments for heart failure with reduced ejection fraction in routine practice: a position statement from a panel of experts ; Optimización de los tratamientos de la insuficiencia cardiaca con fracción de eyección reducida en la práctica diaria: propuesta de un grupo de expertos |
| Authors: |
Girerd, Nicolas; Leclercq, Christophe; Hanon, Olivier; Bayés-Genís, Antoni; Januzzi, James, L; Damy, Thibaut; Lequeux, Benoit; Meune, Christophe; Sabouret, Pierre; Roubille, François |
| Contributors: |
Défaillance Cardiovasculaire Aiguë et Chronique (DCAC); Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL); Centre d'investigation clinique plurithématique Pierre Drouin Nancy (CIC-P); Centre d'investigation clinique Nancy (CIC); Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL); Cardiovascular and Renal Clinical Trialists Vandoeuvre-les-Nancy (INI-CRCT); Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu Nancy; French-Clinical Research Infrastructure Network - F-CRIN Paris (Cardiovascular & Renal Clinical Trialists - CRCT); Laboratoire Traitement du Signal et de l'Image (LTSI); Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM); Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Pontchaillou; Hôpitaux Universitaires Paris Centre; Université Paris Cité (UPCité); Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV); Germans Trias i Pujol University Hospital Badalona, Barcelona, Spain (GTPUH); Massachusetts General Hospital Boston; Harvard Medical School Boston (HMS); Baim Institute for Clinical Research Boston MA; CHU Henri Mondor Créteil; Service de cardiologie CHU de Poitiers; Centre hospitalier universitaire de Poitiers = Poitiers University Hospital (CHU de Poitiers La Milétrie ); Hôpital Avicenne AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); Institut de cardiologie CHU Pitié-Salpêtrière; CHU Pitié-Salpêtrière AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU); Physiologie & médecine expérimentale du Cœur et des Muscles U 1046 (PhyMedExp); Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM) |
| Source: |
ISSN: 1885-5857 ; Revista Española de Cardiología (English version) ; https://hal.univ-lorraine.fr/hal-04029734 ; Revista Española de Cardiología (English version), 2023, 76 (10), pp.813-820. ⟨10.1016/j.rec.2023.03.005⟩. |
| Publisher Information: |
HAL CCSD; Elsevier España |
| Publication Year: |
2023 |
| Collection: |
Université de Rennes 1: Publications scientifiques (HAL) |
| Subject Terms: |
Heart failure; Treatment optimization; Titration; Practice guidelines treatment algorithm; Cardiovascular diseases; [SDV.IB]Life Sciences [q-bio]/Bioengineering; [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system |
| Description: |
International audience ; 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. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/36914024; PUBMED: 36914024 |
| DOI: |
10.1016/j.rec.2023.03.005 |
| Availability: |
https://hal.univ-lorraine.fr/hal-04029734; https://hal.univ-lorraine.fr/hal-04029734v1/document; https://hal.univ-lorraine.fr/hal-04029734v1/file/36914024.pdf; https://doi.org/10.1016/j.rec.2023.03.005 |
| Rights: |
info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.D487DDC |
| Database: |
BASE |