Download Verification of Guidelines-Adherent Medical Therapy in Patients with

Verification of Guidelines-Adherent Medical Therapy in Patients with Sinus Rhythm
Hospitalized Due to Worsening of Heart Failure
Lopatin Y.1, Grebennikova A.1, Sisakian H.2, Hayrapetyan H.3, Pagava Z.4, Chesnikova A.5,
Koziolova N.6, Abdullaev T.7, Berkinbayev S.8, Rakisheva A.8
1Volgograd
State Medical University, Volgograd, Russian Federation; 2 Yerevan State Medical
University, Yerevan, Armenia; 3Erebouni Cardiology Center, Yerevan, Armenia; 4Tbilisi Medical
State University; 5Rostov State Medical University, Rostov-on-Don, Russian Federation; 6Perm
State Medical Academy, Perm, Russian Federation; 7Republic Cardiology Centre, Tashkent,
Uzbekistan; 8Scientific and Research Institute of Cardiology and Internal Diseases, Almaty,
Kazakhstan.
Background. Hospitalization of patients with heart failure (HF) is a good opportunity to reevaluate patient care including optimizing present and planning future management. The aim of
our study was to analyze medical management in patients with sinus rhythm hospitalized due to
worsening of HF, who were included in an ongoing Optimize Heart Failure Care program.
Methods. The Optimize Heart Failure Care program is an international, multi-center patient
support program based on pre-discharge patient education, pre- and post-discharge check-lists
over a period of 12 months. This analysis included data collected over 3 months from 317 patients
(mean age 62.9 ± 0.6 years, 70% male) with sinus rhythm hospitalized due to worsening of HF,
NYHA II-IV (mean 2.81 ± 0.03), left ventricular ejection fraction (LVEF) <40% (mean 31.1 ± 0.5%),
mean systolic/diastolic blood pressure 128.6 ± 1.3/80.8 ± 0.7 mm Hg and mean heart rate (HR)
85.1 ± 1.0 bpm.
Results. The prescription rate of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin
receptor blockers (ARBs), beta-blockers (BBs) and mineralocorticoid receptor antagonists (MRAs)
before discharge from hospital were 92.4%, 82.6% and 90.5%, respectively. Diuretics and digoxin
were recommended in 98.8% and 17.7% of patients with HF, respectively. However, despite high
baseline HR, ivabradine was prescribed in 25.5% of patients with HF only. Interestingly, baseline
HR in this group of patients was significantly higher than in patients who did not receive
ivabradine (91.2 ± 1.7 bpm vs. 83.4 ± 0.9 bpm, p<0.05). There were no differences in terms of
age, sex, NYHA functional class, LVEF between the groups of patients receiving and not receiving
ivabradine. Thus, ivabradine was prescribed in patients with excessively high HR only. On the
other hand, ivabradine therapy was characterized not only with good safety, but also with a
significant reduction of the rate of repeated hospitalizations after 3 months of follow-up (3.7%
versus 17.7% in patients without ivabradine therapy, p<0.05).
Conclusion. Despite the high adherence among cardiologists to prescribing neurohumoral
antagonists and diuretics in patients hospitalized due to worsening of HF, additional efforts are
needed in order to improve the adherence to HR lowering therapy with ivabradine.