American Journal of Cardiovascular Drugs最新文献

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Cost–Utility Analysis of Vericiguat in Heart Failure with Reduced Ejection Fraction After Worsening Heart Failure Events in China 中国心力衰竭事件恶化后射血分数降低型心力衰竭患者服用维力青的成本效用分析
IF 2.8 4区 医学
American Journal of Cardiovascular Drugs Pub Date : 2024-04-15 DOI: 10.1007/s40256-024-00637-5
Penglei Chen, Yixiang Wang, Xin Liu, Jiaqi Yu, Xuwei Zheng
{"title":"Cost–Utility Analysis of Vericiguat in Heart Failure with Reduced Ejection Fraction After Worsening Heart Failure Events in China","authors":"Penglei Chen,&nbsp;Yixiang Wang,&nbsp;Xin Liu,&nbsp;Jiaqi Yu,&nbsp;Xuwei Zheng","doi":"10.1007/s40256-024-00637-5","DOIUrl":"10.1007/s40256-024-00637-5","url":null,"abstract":"<div><h3>Objective</h3><p>Vericiguat is a new medication to demonstrate clinical efficacy in heart failure with reduced ejection fraction (HFrEF) after worsening heart failure (WHF) events, but its cost–utility was unknown. We aimed to assess the cost–utility of combining the application of vericiguat with standard treatment in HFrEF patients who had WHF events.</p><h3>Methods</h3><p>A multistate Markov model was implemented to mimic the economic results of HFrEF patients who had WHF events in China after receiving vericiguat or placebo. An analysis of cost–utility was conducted; most parameters were set according to the published studies and related databases. All the utilities and costs were decreased at a rate of 5% annually. The incremental cost-effectiveness ratios (ICERs) were the primary outcome measure. We also conducted sensitivity analyses.</p><h3>Results</h3><p>Over a 20 year lifetime horizon, additional use of vericiguat led to an elevated cost from US$9725.03 to US$20,660.76 at the current vericiguat costs. This was related to increased quality-adjusted life years (QALYs) from 2.50 to 2.66, along with an ICER of US$65,057.24 per QALY, which was over the willingness-to-pay (WTP) threshold of US$36,096.30 per QALY. If the vericiguat costs were discounted at 80%, it contributed to an ICER of US$12,226.77 per QALY. Additional use of vericiguat for patients with plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) of ≤ 5314 pg per ml produced an ICER of US$23,688.46 per QALY. The outcomes of the one-way sensitivity analysis showed the risk of death from cardiovascular disease in both groups was variable with the highest sensitivity. The probabilistic sensitivity analysis showed that 41.6% of the mimicked population receiving vericiguat combined with standard therapy was cost-effective at the WTP threshold of US$36,096.30 per QALY.</p><h3>Conclusions</h3><p>From the perspective of Chinese public healthcare system, the combined use of vericiguat and standard treatment in patients with HFrEF following WHF events did not generate advantages in cost–utility in China but was a cost-effective therapeutic strategy for those who with plasma NT-proBNP of ≤ 5314 pg per ml.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"445 - 454"},"PeriodicalIF":2.8,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140611171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluation of the Lifetime Benefits of Metformin and SGLT2 Inhibitors in Type 2 Diabetes Mellitus Patients with Cardiovascular Disease: A Systematic Review and Two-Stage Meta-Analysis 评估二甲双胍和 SGLT2 抑制剂对心血管疾病 2 型糖尿病患者的终生益处:系统回顾和两阶段荟萃分析
IF 2.8 4区 医学
American Journal of Cardiovascular Drugs Pub Date : 2024-04-08 DOI: 10.1007/s40256-024-00640-w
Hon Jen Wong, Norman H. Lin, Yao Neng Teo, Nicholas L. Syn, Yao Hao Teo, Ching-Hui Sia
{"title":"Evaluation of the Lifetime Benefits of Metformin and SGLT2 Inhibitors in Type 2 Diabetes Mellitus Patients with Cardiovascular Disease: A Systematic Review and Two-Stage Meta-Analysis","authors":"Hon Jen Wong,&nbsp;Norman H. Lin,&nbsp;Yao Neng Teo,&nbsp;Nicholas L. Syn,&nbsp;Yao Hao Teo,&nbsp;Ching-Hui Sia","doi":"10.1007/s40256-024-00640-w","DOIUrl":"10.1007/s40256-024-00640-w","url":null,"abstract":"<div><h3>Background</h3><p>Metformin and sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardiovascular benefits but their comparative effects on mortality in type 2 diabetes mellitus (T2DM) patients with cardiovascular disease (CVD) are unknown. Hence, we evaluated and compared lifetime benefits arising from metformin or SGLT2 inhibitors in T2DM patients with CVD.</p><h3>Materials and Methods</h3><p>Studies published in the PubMed, EMBASE and CENTRAL databases before 28 October 2023 were retrieved. Treatment effects of metformin against US FDA-approved SGLT2 inhibitors in T2DM patients with CVD were evaluated and lifetime gains in event-free survival were estimated from our primary endpoints of all-cause and cardiovascular mortality. Risk ratios were derived to assess their impact on secondary outcomes such as major adverse cardiovascular events and hospitalizations for heart failure.</p><h3>Results</h3><p>Overall, 14 studies were included. Five studies published Kaplan–Meier curves for the primary outcome of all-cause mortality. Individual participant data were reconstructed from these Kaplan–Meier curves, from which we conducted our two-stage meta-analysis. Participants receiving metformin and SGLT2 inhibitors experienced a reduction in the risk for all-cause mortality as compared with those not taking metformin and placebo. However, participants receiving SGLT2 inhibitors had a higher all-cause mortality (hazard ratio 1.308, 95% confidence interval 1.103–1.550) versus metformin. Treatment with metformin was estimated to offer an additional 23.26 months of survival free from all-cause mortality versus 23.04 months with SGLT2 inhibitors.</p><h3>Conclusions</h3><p>In patients with T2DM and CVD, metformin and SGLT2 inhibitors were associated with substantially lower all-cause mortality rates and slightly longer life expectancies than in patients without. Metformin presented an advantage over SGLT2 inhibitors in reducing all-cause mortality.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"371 - 383"},"PeriodicalIF":2.8,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140581986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trends in Oral Anticoagulant Use and Individual Expenditures Across the United States from 2014 to 2020 2014 至 2020 年全美口服抗凝剂使用和个人支出趋势
IF 2.8 4区 医学
American Journal of Cardiovascular Drugs Pub Date : 2024-04-07 DOI: 10.1007/s40256-024-00638-4
Omar S. Alkhezi, Leo F. Buckley, John Fanikos
{"title":"Trends in Oral Anticoagulant Use and Individual Expenditures Across the United States from 2014 to 2020","authors":"Omar S. Alkhezi,&nbsp;Leo F. Buckley,&nbsp;John Fanikos","doi":"10.1007/s40256-024-00638-4","DOIUrl":"10.1007/s40256-024-00638-4","url":null,"abstract":"<div><h3>Background</h3><p>Landmark clinical trials have expended the indications for the direct oral anticoagulants (DOACs), but contemporary data on usage and expenditure patterns are lacking.</p><h3>Objective</h3><p>This study aimed to assess annual trends in oral anticoagulant (OAC) utilization and expenditure across the United States (US) from 2014 to 2020.</p><h3>Methods</h3><p>We utilized the Medical Expenditure Panel Survey (MEPS) to study the trends of use and expenditures of warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban between 2014 and 2020 in the US. Survey respondents reported OAC use within the past year, which was verified against pharmacy records. Payment information was obtained from the respondent’s pharmacy and was categorized as third-party or self/out-of-pocket. Potential indications and medical conditions of interest for OAC therapy were identified from respondent-reported medical conditions. We estimated the national number of OAC users and total expenditures across age, sex, race, ethnicity, insurance, and medical condition subgroups. Trends of OAC users’ characteristics, expenditure, and number of prescriptions were evaluated using the Mann–Kendall test for trends.</p><h3>Results</h3><p>Between 2014 and 2020, the number of warfarin users decreased from 3.8 million (70% of all OAC users) to 2.2 million (<i>p </i>= 0.007) [29% of all OAC users], while the number of DOAC users increased from 1.6 million (30% of all OAC users) to 5.4 million (<i>p </i>= 0.003) [70% of all OAC users]. The total expenditure of OACs in the US increased from $3.4 billion in 2014 to $17.8 billion in 2020 (<i>p </i>= 0.003), which was driven by the increase in DOAC expenditures (<i>p </i>= 0.003).</p><h3>Conclusions</h3><p>DOACs have replaced warfarin as the preferred OAC in the US. The increased costs associated with DOAC use may decline when generic formulations are approved.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"433 - 444"},"PeriodicalIF":2.8,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative Safety and Efficacy of Low/Moderate-Intensity Statin plus Ezetimibe Combination Therapy vs. High-Intensity Statin Monotherapy in Patients with Atherosclerotic Cardiovascular Disease: An Updated Meta-Analysis 动脉粥样硬化性心血管疾病患者接受低/中等强度他汀加依折麦布联合疗法与高强度他汀单药疗法的安全性和有效性比较:最新大都市分析
IF 2.8 4区 医学
American Journal of Cardiovascular Drugs Pub Date : 2024-04-05 DOI: 10.1007/s40256-024-00642-8
Ishaque Hameed, Syeda Ayesha Shah, Ashnah Aijaz, Hasan Mushahid, Syed Husain Farhan, Muhammad Dada, Adam Bilal Khan, Reeha Amjad, Fawad Alvi, Mustafa Murtaza, Zaid Zuberi, Mohammad Hamza
{"title":"Comparative Safety and Efficacy of Low/Moderate-Intensity Statin plus Ezetimibe Combination Therapy vs. High-Intensity Statin Monotherapy in Patients with Atherosclerotic Cardiovascular Disease: An Updated Meta-Analysis","authors":"Ishaque Hameed,&nbsp;Syeda Ayesha Shah,&nbsp;Ashnah Aijaz,&nbsp;Hasan Mushahid,&nbsp;Syed Husain Farhan,&nbsp;Muhammad Dada,&nbsp;Adam Bilal Khan,&nbsp;Reeha Amjad,&nbsp;Fawad Alvi,&nbsp;Mustafa Murtaza,&nbsp;Zaid Zuberi,&nbsp;Mohammad Hamza","doi":"10.1007/s40256-024-00642-8","DOIUrl":"10.1007/s40256-024-00642-8","url":null,"abstract":"<div><h3>Aim</h3><p>Statin therapy is considered the gold standard for treating hypercholesterolemia. This updated meta-analysis aims to compare the efficacy and safety of a low/moderate-intensity statin in combination with ezetimibe compared with high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (ASCVD).</p><h3>Methods</h3><p>A systematic search of two databases (PubMed and Cochrane CENTRAL) was conducted from inception to January 2023 and a total of 21 randomized clinical trials (RCTs) were identified and included in the analysis. Data were pooled using Hedges’s <i>g</i> and a Mantel–Haenszel random-effects model to derive standard mean differences (SMDs) and 95% confidence intervals (Cis). The primary outcome studied was the effect of these treatments on lipid parameters and safety events.</p><h3>Results</h3><p>The results revealed that combination therapy was more effective in reducing low-density lipoprotein cholesterol (LDL-C) levels (SMD= − 0.41; CI − 0.63 to − 0.19; <i>P</i> = 0.0002). There was no significant change in the levels of high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG), high-sensitivity C-reactive protein (hs-CRP), Apo A1, or Apo B. The safety of these treatments was assessed by the following markers alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine phosphokinase (CK), and a significant difference was only observed in CK (SMD: − 0.81; CI − 1.52 to − 0.10; <i>P</i> = 0.02).</p><h3>Conclusion</h3><p>This meta-analysis demonstrated that the use of low/moderate-intensity statin combination therapy significantly reduced LDL-C levels compared with high-intensity statin monotherapy, making it preferable for patients with related risks. However, further trials are encouraged to evaluate potential adverse effects associated with combined therapy.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"419 - 431"},"PeriodicalIF":2.8,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140581813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Authors’ Reply to Rangwala et al: “Aspirin for the Primary Prevention of Cardiovascular Diseases in Patients with Chronic Kidney Disease: An Updated Meta-analysis” 作者对 Rangwala 等人的回复:"阿司匹林用于慢性肾病患者心血管疾病的一级预防:最新 Meta 分析"。
IF 2.8 4区 医学
American Journal of Cardiovascular Drugs Pub Date : 2024-04-04 DOI: 10.1007/s40256-024-00645-5
Ioannis Bellos, Smaragdi Marinaki, Pagona Lagiou, Vassiliki Benetou
{"title":"Authors’ Reply to Rangwala et al: “Aspirin for the Primary Prevention of Cardiovascular Diseases in Patients with Chronic Kidney Disease: An Updated Meta-analysis”","authors":"Ioannis Bellos,&nbsp;Smaragdi Marinaki,&nbsp;Pagona Lagiou,&nbsp;Vassiliki Benetou","doi":"10.1007/s40256-024-00645-5","DOIUrl":"10.1007/s40256-024-00645-5","url":null,"abstract":"","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"467 - 468"},"PeriodicalIF":2.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment Patterns, Outcomes, and Persistence to Newly Started Heart Failure Medications in Patients with Worsening Heart Failure: A Cohort Study from the United States and Germany 心力衰竭恶化患者的治疗模式、疗效以及对新开始使用的心力衰竭药物的耐受性:来自美国和德国的队列研究
IF 2.8 4区 医学
American Journal of Cardiovascular Drugs Pub Date : 2024-04-04 DOI: 10.1007/s40256-024-00643-7
Alexander Michel, Coralie Lecomte, Christoph Ohlmeier, Hanaya Raad, Frederike Basedow, Dennis Haeckl, Dominik Beier, Thomas Evers
{"title":"Treatment Patterns, Outcomes, and Persistence to Newly Started Heart Failure Medications in Patients with Worsening Heart Failure: A Cohort Study from the United States and Germany","authors":"Alexander Michel,&nbsp;Coralie Lecomte,&nbsp;Christoph Ohlmeier,&nbsp;Hanaya Raad,&nbsp;Frederike Basedow,&nbsp;Dennis Haeckl,&nbsp;Dominik Beier,&nbsp;Thomas Evers","doi":"10.1007/s40256-024-00643-7","DOIUrl":"10.1007/s40256-024-00643-7","url":null,"abstract":"<div><h3>Background</h3><p>Data are limited regarding guideline-directed medical therapy (GDMT) treatment patterns in patients with worsening heart failure (HF).</p><h3>Methods</h3><p>We used administrative claims databases in Germany and the USA to conduct a retrospective cohort study of patients with worsening HF. Two cohorts of patients with prevalent HF and a HF hospitalization (HFH) from 2016 to 2019, alive at discharge (<i>N</i> = 75,140 USA; <i>N</i> = 47,003 Germany) were identified. Index date was the first HFH during the study period. One-year HF rehospitalization and mortality rates were calculated and a composite endpoint of both outcomes assessed using Kaplan–Meier estimation. We evaluated HF medication patterns in the 6 months before and after the index date. New users of a HF medication (at discharge/after index HFH) were followed for 1 year to evaluate persistence (no treatment gaps &gt; 2 months)</p><h3>Results</h3><p>One-year HF rehospitalization rates were 36.2% (USA) and 47.7% (Germany). One year mortality rates were 30.0% (USA) and 23.0% (Germany), and the composite endpoint (mortality/HF rehospitalization) was reached in 55.1 % (USA) and 56.6% (Germany). Kaplan–Meier plots showed the risk for the composite endpoint was high in the early post discharge period. Comparison of patterns pre- and postindex HFH showed some increase in use of mineralocorticoid receptor antagonists (MRAs), angiotensin receptor–neprilysin inhibitor (ARNI), and triple therapy; use of angiotensin-converting enzyme (ACE) inhibitor/ angiotensin receptor blocker (ARB) plus beta-blockers remained constant/slightly declined; &lt; 20% patients received triple therapy (ACE inhibitor/ARB plus beta-blocker plus MRA). A third of patients were new users; 1 year persistence rates were often low.</p><h3>Conclusions</h3><p>Morbidity, mortality, and rehospitalization risk is high among patients with worsening HF; uptake and continuation of GDMT is suboptimal.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"409 - 418"},"PeriodicalIF":2.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140585823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Drug Therapy for Acute and Chronic Heart Failure with Preserved Ejection Fraction with Hypertension: A State-of-the-Art Review 急性和慢性射血分数保留型心力衰竭合并高血压的药物治疗:最新研究综述
IF 2.8 4区 医学
American Journal of Cardiovascular Drugs Pub Date : 2024-04-04 DOI: 10.1007/s40256-024-00641-9
Hiroaki Hiraiwa, Takahiro Okumura, Toyoaki Murohara
{"title":"Drug Therapy for Acute and Chronic Heart Failure with Preserved Ejection Fraction with Hypertension: A State-of-the-Art Review","authors":"Hiroaki Hiraiwa,&nbsp;Takahiro Okumura,&nbsp;Toyoaki Murohara","doi":"10.1007/s40256-024-00641-9","DOIUrl":"10.1007/s40256-024-00641-9","url":null,"abstract":"<div><p>In this comprehensive state-of-the-art review, we provide an evidence-based analysis of current drug therapies for patients with heart failure with preserved ejection fraction (HFpEF) in the acute and chronic phases with concurrent hypertension. Additionally, we explore the latest developments and emerging evidence on the efficacy, safety, and clinical outcomes of common and novel drug treatments in the management of HFpEF with concurrent hypertension. During the acute phase of HFpEF, intravenous diuretics, mineralocorticoid receptor antagonists (MRAs), and vasodilators are pivotal, while in the chronic phase, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have proven effective in enhancing clinical outcomes. However, the use of calcium channel blockers in HFpEF with hypertension should be approached with caution, owing to their potential negative inotropic effects. We also explored emerging drug therapies for HFpEF, such as sodium–glucose co-transporter 2 (SGLT2) inhibitors, angiotensin receptor–neprilysin inhibitor (ARNI), soluble guanylate cyclase (sGC) stimulators, novel MRAs, and ivabradine. Notably, SGLT2 inhibitors have shown promise in reducing heart failure hospitalizations and cardiovascular mortality in patients with HFpEF, regardless of their diabetic status. Additionally, ARNI and sGC stimulators have demonstrated potential in improving symptoms, functional capacity, and quality of life. Nonetheless, additional research is necessary to pinpoint optimal treatment strategies for HFpEF with concurrent hypertension. Furthermore, long-term studies are essential to assess the durability and sustained benefits of emerging drug therapies. Identification of novel targets and mechanisms underlying HFpEF pathophysiology will pave the way for innovative drug development approaches in the management of HFpEF with concurrent hypertension.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"343 - 369"},"PeriodicalIF":2.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40256-024-00641-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140581814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Digoxin is Not Related to Mortality in Patients with Heart Failure: Results from the SELFIE-TR Registry 地高辛与心力衰竭患者的死亡率无关:SELFIE-TR 登记的结果
IF 2.8 4区 医学
American Journal of Cardiovascular Drugs Pub Date : 2024-04-04 DOI: 10.1007/s40256-024-00639-3
Rengin Çetin Güvenç, Tolga Sinan Güvenç, Mert Efe Çağlar, Abdullah Ayar Al Arfaj, Ailin Behrad, Mehmet Birhan Yılmaz
{"title":"Digoxin is Not Related to Mortality in Patients with Heart Failure: Results from the SELFIE-TR Registry","authors":"Rengin Çetin Güvenç,&nbsp;Tolga Sinan Güvenç,&nbsp;Mert Efe Çağlar,&nbsp;Abdullah Ayar Al Arfaj,&nbsp;Ailin Behrad,&nbsp;Mehmet Birhan Yılmaz","doi":"10.1007/s40256-024-00639-3","DOIUrl":"10.1007/s40256-024-00639-3","url":null,"abstract":"<div><h3>Aims</h3><p>Digoxin has been used in the treatment for heart failure for centuries, but the role of this drug in the modern era is controversial. A particular concern is the recent observational findings suggesting an increase in all-cause mortality with digoxin, although such observations suffer from biased results since these studies usually do not provide adequate compensation for the severity of disease. Using a nationwide registry database, we aimed to investigate whether digoxin is associated with 1-year all-cause mortality in patients with heart failure irrespective of phenotype.</p><h3>Methods</h3><p>A total of 1014 out of 1054 patients in the registry, of whom 110 patients were on digoxin, were included in the study. Multivariable adjustments were done and propensity scores were calculated for various prognostic indicators, including signs and symptoms of heart failure and functional capacity. Crude mortality, mortality adjusted for covariates, mortality in the propensity score-matched cohort, and Bayesian factors (BFs) were analyzed.</p><h3>Results</h3><p>Crude 1-year mortality rate did not differ between patients on and off digoxin (17.3% vs 20.1%, log-rank <i>p </i>= 0.46), and digoxin was not related to mortality following multivariable adjustment (hazard ratio 0.87, 95% confidence interval 0.539–1.402, <i>p </i>= 0.57). Similarly, all-cause mortality was similar in 220 propensity-score adjusted patients (17.3% vs 20.0%, log-rank <i>p </i>= 0.55). On Bayesian analyses, there was moderate to strong evidence suggesting a lack of difference between in unmatched cohort (BF<sub>10</sub> 0.091) and weak-to-moderate evidence in the matched cohort (BF<sub>10</sub> 0.296).</p><h3>Conclusions</h3><p>In this nationwide cohort, we did not find any evidence for an increased 1-year mortality in heart failure patients on digoxin.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"399 - 408"},"PeriodicalIF":2.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140585816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advancing Guideline-Directed Medical Therapy in Heart Failure: Overcoming Challenges and Maximizing Benefits 推进指南指导下的心力衰竭药物治疗:克服挑战,实现效益最大化
IF 2.8 4区 医学
American Journal of Cardiovascular Drugs Pub Date : 2024-04-03 DOI: 10.1007/s40256-024-00646-4
Zixi Zhang, Cancan Wang, Tao Tu, Qiuzhen Lin, Jiabao Zhou, Yunying Huang, Keke Wu, Zeying Zhang, Wanyun Zuo, Na Liu, Yichao Xiao, Qiming Liu
{"title":"Advancing Guideline-Directed Medical Therapy in Heart Failure: Overcoming Challenges and Maximizing Benefits","authors":"Zixi Zhang,&nbsp;Cancan Wang,&nbsp;Tao Tu,&nbsp;Qiuzhen Lin,&nbsp;Jiabao Zhou,&nbsp;Yunying Huang,&nbsp;Keke Wu,&nbsp;Zeying Zhang,&nbsp;Wanyun Zuo,&nbsp;Na Liu,&nbsp;Yichao Xiao,&nbsp;Qiming Liu","doi":"10.1007/s40256-024-00646-4","DOIUrl":"10.1007/s40256-024-00646-4","url":null,"abstract":"<div><p>The delayed titration of guideline-directed drug therapy (GDMT) is a complex event influenced by multiple factors that often result in poor prognosis for patients with heart failure (HF). Individualized adjustments in GDMT titration may be necessary based on patient characteristics, and every clinician is responsible for promptly initiating GDMT and titrating it appropriately within the patient’s tolerance range. This review examines the current challenges in GDMT implementation and scrutinizes titration considerations within distinct subsets of HF patients, with the overarching goal of enhancing the adoption and effectiveness of GDMT. The authors also underscore the significance of establishing a novel management strategy that integrates cardiologists, nurse practitioners, pharmacists, and patients as a unified team that can contribute to the improved promotion and implementation of GDMT.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"329 - 342"},"PeriodicalIF":2.8,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40256-024-00646-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140585746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comment on: “Aspirin for the Primary Prevention of Cardiovascular Diseases in Patients with Chronic Kidney Disease: An Updated Meta-analysis” 评论"阿司匹林用于慢性肾病患者心血管疾病的一级预防:最新 Meta 分析 "发表评论。
IF 2.8 4区 医学
American Journal of Cardiovascular Drugs Pub Date : 2024-04-02 DOI: 10.1007/s40256-024-00644-6
Hussain Sohail Rangwala, Hareer Fatima, Burhanuddin Sohail Rangwala
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