Prescription and dosage of RAAS inhibitors in patients with chronic heart failure in the FAR NHL registry
Authors:
Monika Špinarová 1; Jindřich Špinar 2; Jiří Pařenica 2; Lenka Špinarová 1; Filip Málek 3; Karel Lábr 1; Ondřej Ludka 2; Jiří Jarkovský 4
Authors‘ workplace:
I. interní kardio-angiologická klinika LF MU a FN u sv. Anny v Brně
1; Interní kardiologická klinika LF MU a FN Brno, pracoviště Bohunice
2; Kardiologické oddělení Nemocnice Na Homolce, Praha
3; Institut biostatistiky a analýz LF MU, Brno
4
Published in:
Vnitř Lék 2019; 65(1): 13-14
Category:
Original Contributions
Chronické srdeční selhání se sníženou ejekční frakcí levé komory je časté onemocnění se závažnou prognózou. Léčba se zaměřuje především na zlepšení symptomů a prevenci progrese choroby. Mezi léky první volby patří blokátory systému renin-angiotenzin-aldosteron (RAAS), tedy ACE inhibitory (ACEI) a sartany (ARB).
Overview
Background:
Congestive heart failure with reduced ejection fraction is a common clinical condition with a serious prognosis. Treatment focuses on improving the symptoms and preventing the progression of the disease. First-line therapy include angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs).
Methods:
These data come from the FAR NHL registry (FARmacology and NeuroHumoraL activation). This is a multicenter database of patients with stable systolic heart failure (EF < 50 %) collected between November 2014 and November 2015.
Results:
A population of 1 100 patients was evaluated, the mean age was 65 years, 80.8 % were male. The etiology of heart failure was ischemic heart disease (49.7 %), dilated cardiomyopathy (41.7 %) and other (8.6 %). The total prescription of ACEI/ARB was 88.4 %, the most commonly prescribed ACEI were ramipril and perindopril, ARB was losartan. The prescription of ACEI/ARBs decreased with the severity of the disease according to NYHA classification (all 88.4 %, NYHA I 95.2 %, NYHA II 89.0 %, NYHA III-IV 83.5 %, p < 0.001). 129 subjects (11.6 %) were not treated by ACEI/ARBs at all. The target dose of ACEI/ARB, as it is recommended in the ESC Guidelines, was admissioned to only 13.5 % of patients. The dose was decreasing with the severity of disease evaluated by NYHA, NT-proBNP value, systolic blood pressure and renal functions.
Conclusions:
These data show the tendency of pharmacological prescription of RAAS blockers (including doses), which reflects not only the severity of heart failure but also renal functions and blood pressure and points to possible reserves in up-titration of the target dose.
Key words:
angiotensin-converting enzyme inhibitors – angiotensin receptor blockers – FAR NHL – heart failure – pharmacotherapy – registry – target dose
Sources
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