Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology

Giuseppe M.C. Rosano, Brenda Moura, Marco Metra, Michael Böhm, Johann Bauersachs, Tuvia Ben Gal, Stamatis Adamopoulos, Magdy Abdelhamid, Vasiliki Bistola, Jelena Čelutkienė, Ovidiu Chioncel, Dimitrios Farmakis, Roberto Ferrari, Gerasimos Filippatos, Loreena Hill, Ewa A. Jankowska, Tiny Jaarsma, Pardeep Jhund, Mitja Lainscak, Yuri LopatinLars H. Lund, Davor Milicic, Wilfried Mullens, Fausto Pinto, Piotr Ponikowski, Gianluigi Savarese, Thomas Thum, Maurizio Volterrani, Stefan D. Anker, Petar M. Seferovic, Andrew J.S. Coats

Research output: Contribution to journalArticlepeer-review

Abstract

Despite guideline recommendations and available evidence, implementation of treatment in heart failure (HF) is poor. The majority of patients are not prescribed drugs at target doses that have been proven to positively impact morbidity and mortality. Among others, tolerability issues related to low blood pressure, heart rate, impaired renal function or hyperkalaemia are responsible. Chronic kidney disease plays an important role as it affects up to 50% of patients with HF. Also, dynamic changes in estimated glomerular filtration rate may occur during the course of HF, resulting in inappropriate dose reduction or even discontinuation of decongestive or neurohormonal modulating therapy in clinical practice. As patients with HF are rarely naïve to pharmacologic therapies, the challenge is to adequately prioritize or select the most appropriate up-titration schedule according to patient profile. In this consensus document, we identified nine patient profiles that may be relevant for treatment implementation in HF patients with a reduced ejection fraction. These profiles take into account heart rate (<60 bpm or >70 bpm), the presence of atrial fibrillation, symptomatic low blood pressure, estimated glomerular filtration rate (<30 or >30 mL/min/1.73 m2) or hyperkalaemia. The pre-discharge patient, frequently still congestive, is also addressed. A personalized approach, adjusting guideline-directed medical therapy to patient profile, may allow to achieve a better and more comprehensive therapy for each individual patient than the more traditional, forced titration of each drug class before initiating treatment with the next.

Original languageEnglish
Pages (from-to)872-881
Number of pages10
JournalEuropean Journal of Heart Failure
Volume23
Issue number6
DOIs
Publication statusPublished - Jun 2021

Keywords

  • Atrial fibrillation
  • Blood pressure
  • Chronic kidney disease
  • Clinical profiles
  • Guideline-directed medical therapy
  • Heart failure
  • Heart rate
  • Hyperkalaemia
  • Pre-discharge patient

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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