Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado

Background: Pharmacological treatment improves survival in patients with heart failure with reduced ejection fraction. The use of sacubutril/valsartan and ivabradine has been recently approved and incorporated in the latest guidelines. Aim: To identify candidates eligible for these therapies among...

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Autores principales:	Rossel,Víctor, Duarte,Manuel, Muñoz,Pilar, Bravo,Catherine, Bobadilla,Gustavo, Verdugo,Fernando, Guardamagna,Carmen
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2019
Materias:	Drug Therapy Heart Diseases Heart Failure Ivabradine
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872019000300330
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spelling	oai:scielo:S0034-988720190003003302019-07-17Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializadoRossel,VíctorDuarte,ManuelMuñoz,PilarBravo,CatherineBobadilla,GustavoVerdugo,FernandoGuardamagna,Carmen Drug Therapy Heart Diseases Heart Failure Ivabradine Background: Pharmacological treatment improves survival in patients with heart failure with reduced ejection fraction. The use of sacubutril/valsartan and ivabradine has been recently approved and incorporated in the latest guidelines. Aim: To identify candidates eligible for these therapies among patients treated in a heart failure clinic, considering the inclusion criteria for the PARADIGM-HF and SHIFT trials. Material and Methods: Cross-sectional study on 158 patients aged 62 ± 11 years (67% male) with heart failure and reduced ejection fraction, with at least three months of follow-up and without decompensation. The percentage of patients complying for the inclusion criteria for the PARADIGM-HF y SHIFT trials was determined. Results: In 37%, the etiology of heart failure was ischemic, 49% were in functional class I, their ejection fraction was 33 ± 11% and their median Pro-brain natriuretic peptide was 800 pg/mL. Ninety five percent were treated with vasodilators, 97% with beta-blockers and 82% with aldosterone antagonists. Using PARADIGM-HF and SHIFT criteria, 11 patients (7%) were eligible for sacubitril / valsartan and 21 patients (13.3%) for ivabradine. Among the main causes of non-eligibility for sacubitril / valsartan were being functional class I (48.7%) and not achieving a stable dose of enalapril ≥ 20 mg / day or losartan ≥ 100 mg / day (24.7%). In the case of ivabradine, apart from those in functional class I, the absence of sinus rhythm and a heart rate < 70 / min when receiving a maximal tolerated dose of beta-blockers, were present in 22%. Conclusions: A low percentage of our patients were eligible for these therapies. Among the causes that explain these results were clinical stability, a high percentage of patients in functional class I and being in a disease modifying treatment.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.147 n.3 20192019-03-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872019000300330es10.4067/S0034-98872019000300330
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Drug Therapy Heart Diseases Heart Failure Ivabradine
spellingShingle	Drug Therapy Heart Diseases Heart Failure Ivabradine Rossel,Víctor Duarte,Manuel Muñoz,Pilar Bravo,Catherine Bobadilla,Gustavo Verdugo,Fernando Guardamagna,Carmen Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado
description	Background: Pharmacological treatment improves survival in patients with heart failure with reduced ejection fraction. The use of sacubutril/valsartan and ivabradine has been recently approved and incorporated in the latest guidelines. Aim: To identify candidates eligible for these therapies among patients treated in a heart failure clinic, considering the inclusion criteria for the PARADIGM-HF and SHIFT trials. Material and Methods: Cross-sectional study on 158 patients aged 62 ± 11 years (67% male) with heart failure and reduced ejection fraction, with at least three months of follow-up and without decompensation. The percentage of patients complying for the inclusion criteria for the PARADIGM-HF y SHIFT trials was determined. Results: In 37%, the etiology of heart failure was ischemic, 49% were in functional class I, their ejection fraction was 33 ± 11% and their median Pro-brain natriuretic peptide was 800 pg/mL. Ninety five percent were treated with vasodilators, 97% with beta-blockers and 82% with aldosterone antagonists. Using PARADIGM-HF and SHIFT criteria, 11 patients (7%) were eligible for sacubitril / valsartan and 21 patients (13.3%) for ivabradine. Among the main causes of non-eligibility for sacubitril / valsartan were being functional class I (48.7%) and not achieving a stable dose of enalapril ≥ 20 mg / day or losartan ≥ 100 mg / day (24.7%). In the case of ivabradine, apart from those in functional class I, the absence of sinus rhythm and a heart rate < 70 / min when receiving a maximal tolerated dose of beta-blockers, were present in 22%. Conclusions: A low percentage of our patients were eligible for these therapies. Among the causes that explain these results were clinical stability, a high percentage of patients in functional class I and being in a disease modifying treatment.
author	Rossel,Víctor Duarte,Manuel Muñoz,Pilar Bravo,Catherine Bobadilla,Gustavo Verdugo,Fernando Guardamagna,Carmen
author_facet	Rossel,Víctor Duarte,Manuel Muñoz,Pilar Bravo,Catherine Bobadilla,Gustavo Verdugo,Fernando Guardamagna,Carmen
author_sort	Rossel,Víctor
title	Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado
title_short	Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado
title_full	Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado
title_fullStr	Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado
title_full_unstemmed	Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado
title_sort	pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado
publisher	Sociedad Médica de Santiago
publishDate	2019
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872019000300330
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Pacientes elegibles para las nuevas terapias de la insuficiencia cardíaca en un policlínico especializado

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