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dc.contributor.authorKobayashi, Masatake
dc.contributor.authorVoors, Adriaan A.
dc.contributor.authorOuwerkerk, Wouter
dc.contributor.authorDuarte, Kevin
dc.contributor.authorGirerd, Nicolas
dc.contributor.authorRossignol, Patrick
dc.contributor.authorMetra, Marco
dc.contributor.authorLang, Chim C.
dc.contributor.authorNg, Leong L.
dc.contributor.authorFilippatos, Gerasimos
dc.contributor.authorDickstein, Kenneth
dc.contributor.authorvan Veldhuisen, Dirk J.
dc.contributor.authorZannad, Faiez
dc.contributor.authorFerreira, João Pedro
dc.description.abstractBackground Achieving target doses of angiotensin-converting-enzyme inhibitor/angiotensin-receptor blockers (ACEi/ARB) and beta-blockers in heart failure with reduced ejection fraction (HFrEF) is often underperformed. In BIOlogy Study to TAilored Treatment in chronic heart failure (BIOSTAT-CHF) study, many patients were not up-titrated for which no clear reason was reported. Therefore, we hypothesized that perceived-risk profile might influence treatment optimization. Methods We studied 2100 patients with HFrEF (LVEF≤40%) to compare the clinical characteristics and adverse events associated with treatment up-titration (after a 3-month titration protocol) between; a) patients not reaching target doses for unclear reason; b) patients not reaching target doses due to symptoms and/or side effects; c) patients reaching target doses. Results For ACEi/ARB, (a), (b) and (c) was observed in 51.3%, 25.9% and 22.7% of patients, respectively. For beta-blockers, (a), (b) and (c) was observed in 67.5%, 20.2% and 12.3% of patients, respectively. By multinomial logistic regression analysis for ACEi/ARB, patients in group (a) and (b) had lower blood pressure and poorer renal function, and patients in group (a) were older and had lower ejection fraction. For beta-blockers, patients in group (a) and (b) had more severe congestion and lower heart rate. At 9 months, adverse events (i.e., hypotension, bradycardia, renal impairment, and hyperkalemia) occurred similarly among the three groups. Conclusions Patients in whom clinicians did not give a reason why up-titration was missed were older and had more co-morbidities. Patients in whom up-titration was achieved did not have excess adverse events. However, from these observational findings, the pattern of subsequent adverse events among patients in whom up-titration was missed cannot be determined.en_US
dc.rightsNavngivelse 4.0 Internasjonal*
dc.titlePerceived risk profile and treatment optimization in heart failure: an analysis from BIOlogy Study to TAilored Treatment in chronic heart failureen_US
dc.typeJournal articleen_US
dc.typePeer revieweden_US
dc.rights.holderCopyright 2021 The Author(s)en_US
dc.source.journalClinical Cardiologyen_US
dc.identifier.citationClinical Cardiology. 2021, 44 (6), 780-788.en_US

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Navngivelse 4.0 Internasjonal
Except where otherwise noted, this item's license is described as Navngivelse 4.0 Internasjonal