Intensive Titration of Heart Failure Medications Cuts Need for Device Therapy: Presented at HFSA

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Title: Intensive Titration of Heart Failure Medications Cuts Need for Device Therapy: Presented at HFSA
URL: http://www.pslgroup.com/dg/22D746.htm
Doctor's Guide
September 24, 2008

By Jill Stein

TORONTO -- September 23, 2008 -- Intensive titration of heart failure medications improves ejection fraction (EF) to ranges where cardiac device therapy is not indicated, researchers reported here at the Heart Failure Society of America (HFSA) 12th Annual Scientific Meeting.

Kalkidan Bishu, MD, Veterans Administration Medical Center, Minneapolis, Minnesota, and associates set out to examine to what extent aggressive titration of heart failure medications to target doses improves EF and decreases the need for device therapy.

"Heart failure guidelines recommend that device therapy including implantable cardioverter defibrillators [ICDs] and cardiac resynchronisation therapy [CRT] be considered for left ventricular dysfunction after maximal optimisation of medical therapy," Dr. Bishu said in a presentation on September 23.

"Heart failure medication doses are often not optimised in clinical practice because of the difficulty in organising frequent clinic visits and perceived medication side effects," he explained.

In their study, Dr. Bishu and colleagues enrolled patients with a diagnosis of heart failure, New York Heart Association Class I-III, systolic dysfunction, and left ventricular EF

<35%, who had been referred to a nurse-managed heart failure clinic for titration of their heart failure medication.

Heart failure medications were up-titrated using regular telephone calls and clinic visits, when needed.

Of the 46 patients who qualified for ICD/CRT devices at baseline and had EF measurement available postoptimisation, EF increased to greater than or equal to 35% after optimisation of heart failure medications in 20 (42%), thereby rendering those patients no longer candidates for devices.

Also, 22 (47.8%) patients reached target doses of beta-blockers and 26 (57%) patients reached target doses of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers at optimisation. Target doses were not different between those patients who reached an EF >=35% and those whose EF remained <35%.

The only baseline characteristic that was different between patients with postoptimisation EF >=35% versus EF <35% was mean heart rate (81.7 +-

12.6 vs 74.2 +-

12.1 BPM, respectively, P =

.04).

Dr. Bishu said that the results indicate that intensive titration of heart failure medications can improve EF above the recommended range for device therapy in a significant number of patients, which may potentially decrease healthcare costs.

[Presentation Title: Intensive Titration of Heart Failure Medications Reduces the Need for Device therapy. Abstract 375]

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