TY - JOUR
TI - Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology
AU - Rosano, G.M.C.
AU - Moura, B.
AU - Metra, M.
AU - Böhm, M.
AU - Bauersachs, J.
AU - Ben Gal, T.
AU - Adamopoulos, S.
AU - Abdelhamid, M.
AU - Bistola, V.
AU - Čelutkienė, J.
AU - Chioncel, O.
AU - Farmakis, D.
AU - Ferrari, R.
AU - Filippatos, G.
AU - Hill, L.
AU - Jankowska, E.A.
AU - Jaarsma, T.
AU - Jhund, P.
AU - Lainscak, M.
AU - Lopatin, Y.
AU - Lund, L.H.
AU - Milicic, D.
AU - Mullens, W.
AU - Pinto, F.
AU - Ponikowski, P.
AU - Savarese, G.
AU - Thum, T.
AU - Volterrani, M.
AU - Anker, S.D.
AU - Seferovic, P.M.
AU - Coats, A.J.S.
JO - European Journal of Heart Failure
PY - 2021
VL - 23
TODO - 6
SP - 872-881
PB - John Wiley and Sons Ltd
SN - null
TODO - 10.1002/ejhf.2206
TODO - angiotensin receptor antagonist;  beta adrenergic receptor blocking agent;  bronchodilating agent;  calcium channel blocking agent;  corticosteroid;  dipeptidyl carboxypeptidase inhibitor;  diuretic agent;  ivabradine;  mineralocorticoid antagonist;  nonsteroid antiinflammatory agent;  sodium glucose cotransporter 2 inhibitor, anemia;  Article;  atrial fibrillation;  bleeding;  blood pressure;  cachexia;  cardiology;  chronic kidney failure;  chronotropism;  consensus development;  coronary artery disease;  coughing;  dehydration;  depression;  diabetes mellitus;  drug therapy;  elevated blood pressure;  erectile dysfunction;  estimated glomerular filtration rate;  genital tract infection;  guideline directed medical therapy;  gynecomastia;  heart ejection fraction;  heart failure;  heart rate;  hospital discharge;  human;  hyperkalemia;  hypertension;  hyperuricemia;  hypokalemia;  hypomagnesemia;  hyponatremia;  hypotension;  hypovolemia;  iron deficiency;  kidney dysfunction;  kidney failure;  kidney function;  lung disease;  personalized medicine;  sinus rhythm;  systolic blood pressure;  consensus;  glomerulus filtration rate;  heart failure;  heart left ventricle function;  heart stroke volume, Cardiology;  Consensus;  Glomerular Filtration Rate;  Heart Failure;  Humans;  Stroke Volume;  Ventricular Dysfunction, Left
TODO - 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. © 2021 European Society of Cardiology
ER -