Clinical ResearchPatient Eligibility for Established and Novel Guideline-Directed Medical Therapies After Acute Heart Failure Hospitalization
Central Illustration
Section snippets
Study design and patient population
CAN-HF (Canadian Heart Failure) registry was a retrospective, observational, nonrandomized study of consecutive patients with HF who were inpatient with AHF as primary reason for admission. The design and basic methodology of the CAN-HF registry is reported in a prior publication.19 In brief, patients were enrolled at 7 sites across Quebec, Ontario, Manitoba, and British Columbia between January 2017 and April 2020. There were no exclusion criteria. Chart abstraction of admission and discharge
Baseline characteristics
Across the 7 participating centers, 943 patients were hospitalized with AHF, of whom 869 were discharged alive: 455 with HFrEF and 354 with HFpEF, excluding 60 patients in whom no LVEF data were recorded (Figure 1). Decompensation of chronic HF was more common than de novo presentations, representing 64.2% and 65.8% of admissions with HFrEF and HFpEF, respectively. The median hospital length of stay among all AHF patients was 7 days (IQR: 4-12 days). Patients with HFpEF compared with HFrEF were
Discussion
In this cohort of consecutive HFrEF patients admitted with AHF, 74% to 95% of patients were eligible for 1 of the 4 foundational therapies, and almost three-quarters were eligible for combined quadruple therapy. Furthermore, there is considerable opportunity for adjunct use of novel pharmacotherapies that are less commonly prescribed, such as ivabradine, or not yet approved, such as vericiguat and omecamtiv mecarbil. Similarly, an estimated 3 of 5 patients with HFpEF would be eligible for
Conclusions
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. 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. Every attempt should be made to initiate GDMT in all eligible patients before discharge,
Funding Support and Author Disclosures
CAN-HF was funded by Novartis Canada. This study was supported by the Canadian Cardiovascular Institute (CCI-CIC). Dr Hawkins has received speaker and research fees from Novartis; and has received speaker fees from Boehringer Ingelheim. Dr McKelvie has received speaker and research fees from Novartis, Boehringer Ingelheim, AstraZeneca, and Bayer. Dr Joncas has received research grant support or served on advisory boards for and speaking engagements with AstraZeneca, Amgen, Bayer, Boehringer
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Cited by (6)
Access to Heart Failure Services in Canada: Findings of the Heart and Stroke National Heart Failure Resources and Services Inventory
2023, Canadian Journal of CardiologyTime Is of the Essence
2023, JACC: Heart FailureChallenges in the Implementation of Medical Therapy in Heart Failure
2023, JACC: Heart FailureEligibility for the 4 Pharmacological Pillars in Heart Failure With Reduced Ejection Fraction at Discharge
2023, Journal of the American Heart Association
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