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Pharmacologic Management of Heart Failure with Preserved Ejection Fraction (HFpEF) in Older Adults.
Drugs Aging
January 2025
Program for the Care and Study of the Aging Heart, Department of Medicine, Weill Cornell Medicine, 420 East 70th St, New York, NY, LH-36510063, USA.
There are several pharmacologic agents that have been touted as guideline-directed medical therapy for heart failure with preserved ejection fraction (HFpEF). However, it is important to recognize that older adults with HFpEF also contend with an increased risk for adverse effects from medications due to age-related changes in pharmacokinetics and pharmacodynamics of medications, as well as the concurrence of geriatric conditions such as polypharmacy and frailty. With this review, we discuss the underlying evidence for the benefits of various treatments in HFpEF and incorporate key considerations for older adults, a subpopulation that may be at higher risk for adverse drug events.
View Article and Find Full Text PDF[Clinical characteristics and pharmacological treatment of patients with heart failure in a primary health care cohort].
Aten Primaria
January 2025
Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Institut Català de la Salut, Barcelona, España.
Objective: To characterise patients with heart failure (HF) in Primary Health Care (PHC) and describe their socio-demographic and clinical characteristics and pharmacological treatment.
Design: Descriptive cohort study. SITE: Information System for the Development of Research in Primary Care (SIDIAP), which captures information from the electronic health records of PHC of the Catalan Institute of Health (approximately 80% of the Catalan population).
Efficacy of angiotensin receptor neprilysin inhibitor in hypertension management: A systematic review and meta-analysis of clinical trials.
Narra J
December 2024
Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Dysregulation of renin-angiotensin-aldosterone system (RAAS) often leads to hypertension and severe cardiorenal complications. Although RAAS-targeted therapies have proven effective, it remains yet optimal in reducing cardiovascular events. The aim of this study was to evaluate the efficacy and safety of angiotensin receptor neprilysin inhibitor (ARNI) compared to control in patients with hypertension.
View Article and Find Full Text PDF[Patient with type 2 diabetes and progressive chronic kidney disease].
Rev Med Liege
January 2025
Service de Néphrologie, Dialyse, Transplantation, CHU Liège, Belgique.
Chronic kidney disease (CKD) is a common and severe complication in patients with type 2 diabetes (T2D). While inhibitors of the renin-angiotensin system remained for a long time the only medications that had proven nephroprotective effects, several other pharmacological classes also recently showed such a benefit : sodium-glucose cotransporter type 2 (SGLT2) inhibitors (gliflozins), glucagon-like peptide-1 receptor agonists (semaglutide), and mineralocorticoid receptor antagonists (MRA, finerenone). This clinical vignette aims at explaining the pharmacotherapy strategy for a patient with T2D who presents a progressive CKD.
View Article and Find Full Text PDFInitiation and sequencing of guideline-directed medical therapy for heart failure across the ejection fraction spectrum.
Heart Fail Rev
January 2025
Duke Clinical Research Institute, 300 West Morgan Street, Durham, NC, 27701, USA.
Strong evidence supports the importance of rapid sequence or simultaneous initiation of quadruple guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) for substantially reducing risk of mortality and hospitalization. Barring absolute contraindications for each individual medication, employing the strategy of rapid sequence, simultaneous, and/or in-hospital initiation at the time of HF diagnosis best ensures patients with HFrEF have the opportunity to benefit from proven medications and achieve large absolute risk reductions for adverse clinical outcomes. However, despite guideline recommendations supporting this approach, implementation in clinical practice remains persistently low, with less than one-fifth of eligible patients being prescribed the quadruple GDMT regimen.
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