Optimal medical treatment for heart failure with reduced ejection fraction

master's thesis

• Title (croatian): Optimalna medikamentna terapija u bolesnika s reduciranom sistoličkom funkcijom
• Author: Mohammad Tareq Rahimy
• Mentor: Boško Skorić (mentor)
• Committee member: Davor Miličić (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

This study assessed the optimal medical therapy for HFrEF among patients in the outpatient clinic of University Hospital Centre Zagreb during the last year and compared the results with a study done by the Croatian HF registry in 2011. I measured improvements in the therapy and compared the results with similar studies performed in the UK. Patients attending outpatient clinic on Wednesdays at Clinical Hospital Centre Zagreb for the past year were audited. The data collected included clinical features of HF, medications and the doses of medication prescribed which were then compared with the current ESC guidelines. In total, 108 patients were included in the study. Of which, 83 were men (76%) and 25 women (24%). Predominant HF etiology included, dilated cardiomyopathy (49%), ischemic cardiomyopathy (33%) and hypertensive cardiomyopathy (5%). All patients had reduced left ventricular EF and were on HF medication. Ninety-five percent of the patients received beta-blockers (compared
with 58% in 2011), 53% were on an ACEI or an ARB (compared with 60% in 2011), 87% received a MRA (compared with 44% in 2011) and 89% were on diuretics (compared with 86% in 2011). Digoxin was given to only 7.5% (compared with 30%
in 2011) and ivabradine was used by 3 patients (2.8%). Although this study demonstrated that there is an increase in prescribed doses of HF optimal medication, the mean daily dose of most medical therapy is still significantly below the maximum tolerated evidence-based doses as recommended by the ESC guidelines of 2016.

Abstract (croatian)

U ovom diplomskom radu ispitao sam učestalost propisivanja optimalne medikamentne terapije u bolesnika s popuštanjem srca s reduciranom istisnom frakcijom (HFrEF, engl. heart failure with reduced ejection fraction) i usporedio dobivene rezultate s izvješćem Hrvatskog registra bolesnika sa zatajivanjem srca iz 2011. godine. Mjerio sam poboljšanja u terapiji i usporedio dobivene rezultate sa sličnim studijama provedenim u Velikoj Britaniji. U ispitivanje su uključeni bolesnici koji su posjetili Ambulantu za zatajivanje srca srijedom u Kliničkom bolničkom centru Zagreb tijekom protekle godine. Prikupljeni podaci uključili su kliničke značajke HFrEF-a, vrste i propisane doze lijekova koji su zatim uspoređeni s važećim smjernicama Europskog kardiološkog društva. Ukupno je uključeno 108 bolesnika, od čega 83 muškarca (76%) i 25 žena (24%). Glavni uzroci HFrEF-a bili su dilatacijska kardiomiopatija (49%), ishemijska kardiomiopatija (33%) i hipertenzivna kardiomiopatija (5%). Svi bolesnici imali su disfunkciju LV s reduciranom EF i liječeni su lijekovima za srčano popuštanje.
Devedeset pet posto bolesnika primalo je beta-blokatore (u usporedbi s 58% u 2011.), 53% je uzimalo ACEI ili ARB (u usporedbi s 60% u 2011.), 87% je liječeno MRA (u usporedbi s 44% u 2011.) i 89% je bilo na diureticima (u usporedbi s 86% u 2011). Digoksin je propisan samo u 7,5% (u usporedbi s 30% u 2011.), dok je ivabradin propisan samo u 2,8%. Ovo istraživanje je pokazalo da usprkos porastu učestalosti propisivanja lijekova za optimalno liječenje bolesnika s HFrEF, srednja dnevna doza lijekova u većine bolesnika i dalje je znatno ispod maksimalnih doza kakve su preporučene u posljednjim Smjernicama ESC za liječenje bolesnika sa zatajivanjem srca iz 2016. godine.

• Keywords: heart failure with reduced ejection fraction; left ventricular systolic dysfunction; heart failure management; ACE inhibitor; mineralocorticoid receptor antagonist; beta-blocker; angiotensin receptor-neprilysin inhibitor
• Keywords (croatian): optimalno liječenje bolesnika s HFrEF; disfunkcija LV s reduciranom EF; ACEI; ARB
• Language: english
• URN:NBN: urn:nbn:hr:105:518918
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-04-18 11:45:00