ESC Congress 2017 In Review -- Main Edition - 15D

Excellence recommends that HF patients have a followup clinical assessment within 2 weeks of hospital discharge.40 However, < 10% of HF patients are seen in the
cardiology clinic within 2 weeks of discharge from a
United Kingdom hospital.
Michael Böhm, MD, University of Saarland, Homburg,
Saarland, Germany, pointed out that a post-hoc analysis of the SHIFT trial showed that chronic exposure to
ivabradine reduces readmissions in the vulnerable phase
after hospitalisation for worsening systolic HF (Figure 5).41

Cumulative incidence of all-cause hospitalisations
following first hospitalisation for heart faillure
(mean number of events/patient)

Figure 5. Cumulative Incidence of All-Cause Hospitalisations Following
First Hospitalisation for HF: Ivabradine vs Placebo
5

IRR = .79
(0.63-0.99)

4

IRR = .75
(0.58-0.98)

3

Alexander Lyon, MD, Royal Brompton Hospital,
London, United Kingdom, noted that HF patients experience a wide range of comorbidities, whether related to
CV disease or beyond the heart and blood vessels, including renal impairment, lung disease, anaemia, iron deficiency, cancer, depression, and many others. The SHIFT
trial reported that HF outcomes are significantly influenced by the presence and number of comorbidities.45
In the SHIFT trial, the CV effects and safety of
ivabradine were similar in patients with and without
chronic obstructive pulmonary disease, renal dysfunction, and diabetes.45-48
Treatment of patients with HF and comorbidities
requires careful drug selection. Some comorbidities
have guideline-specific treatments. The presence of
comorbidities should not prevent optimal treatment of
HF patients with effective HF therapies.

Placebo
IRR = .70
(0.50-1.00)

2

References

Ivabradine

1

0
0

Ivabradine/placebo
Patients at risk
514/672
Number of events
0/0

1
454/590
54/102

Time (m)

2

3

424/551
115/201

398/524
166/278

Cumulative rate of all-cause hospitalisation. IRR, incidence rate ratio adjusted for prognostic
factor at 1, 2, and 3 months (95% confidence interval).

Reproduced from Komajda M, Cowie MR, Tavazzi L, et al. Physicians' guideline
adherence is associated with better prognosis in outpatients with heart failure
with reduced ejection fraction: the QUALIFY international registry. Eur J Heart
Fail. 2017. doi: 10.1002/ejhf.887. With permission from John Wiley and Sons.

After SHIFT was published, Dr Cowie evaluated heart
rate control in his practice and found that about half
of his patients had a heart rate > 70 bpm. Although 20
patients could not tolerate ß-blockers, 54 were on the
maximal tolerated dose.42
A new SHIFT analysis showed that outcomes are
independently related to the duration of HF. Patients
with longer disease duration, especially ≥ 10 years, had
an increased risk for the primary outcome, hospitalisation for HF, CV death, and all-cause death.43
The Optimize Heart Failure Care Program was developed to improve HF management.44 The system provides
tools such as protocols for hospitals to adapt to their local
situations, pre- and post-hospital discharge checklists,
and tools for patient education and follow-up, including
a My Heart Failure Passport and MyHF smartphone app.
The program is currently used in over 45 countries.
Optimisation before discharge is the key action in HF
care. HF treatment should target the vulnerable phase
and reduce hospitalisations.

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Mancia G et al. J Hypertens. 2013;31:1281-357.
Mancia G et al. J Hypertens. 2017;35:225-33.
Brown MJ et al. Lancet. 2011;377:312-20.
Weber MA et al. Lancet. 2004;363:2049-51.
Egan BM et al. Hypertension. 2012;59:1124-31.
Gradman AH et al. Hypertension. 2013:61:309-18.
Corrao G et al. Hypertension. 2011;58:566-72.
Poulter N et al. In preparation.
Makani H et al. Am J Med. 2011;124:128-35.
Wang TD et al. Hypertension. 2014;63:958-67.
Simons LA, Chung E, Ortiz M. Curr Med Res Opin. 2017;33:1783-87.
Huang FY et al. Medicine (Baltimore). 2016;95:e3117.
Crea F, Camici PG, Bairey Merz CN. Eur Heart J. 2014;35:1101-111.
Detry JM et al. Br J Clin Pharmacol. 1994;37:279-88.
Szwed H et al. Eur Heart J. 2001;22:2267-74.
Bonello L et al. Heart. 2007;93:703-7.
Chen J et al. Int J Cardiol. 2014;174:634-9.
Lopatin YM. Eur Heart J. 2011;32(Abstract Suppl):569.
Lopatin YM. Eur Heart J. 2010;31(Abstract Suppl).
El-Kady T et al. Am J Cardiovasc Drugs. 2005;5:271-8.
Fragasso G et al. Int J Cardiol. 2013;163:320-5.
Abdallah MS et al. JAMA. 2013;310:1581-90.
Farkouh ME et al. J Am Coll Cardiol. 2013;61:1607-15.
Kurlansky P et al. Circulation. 2016;134:1238-46.
Huffman MD, Xavier D, Perel P. Lancet. 2017;389:1055-65.
Steg PA et al. JAMA Intern Med. 2014;174:1651-59.
Diaz A et al. Eur Heart J. 2005;26:967-74.
Tardif JC. Drugs Today (Barc). 2008;44:171-81.
Tardif JC, Ponikowski P, Kahan T. Eur Heart J. 2009;30:540-8.
Tardif JC et al. Eur Heart J. 2009;30(5):540-8.
Lopatin YM et al. Int J Cardiol. 2016;15:203:909-15.
Vitale C et al. Int J Cardiol. 2013;168:1078-81.
Danchin N. Eur Heart J. 2009;30:2297-9.
Amosova E et al. Cardiovasc Drugs Ther. 2011;25:531-7.
Ferrari R et al. Nat Rev Cardiol. 2017; doi: 10.1038/nrcardio.2017.131.
Heidenreich PA et al. J Am Coll Cardiol. 2010;56:362-8.
Maggioni AP et al. Eur J Heart Fail. 2013;15:808-17.
Komajda M et al. Eur J Heart Fail. 2017; doi: 10.1002/ejhf.887.
Ponikowski P et al. Eur Heart J. 2016;37:2129-200.
National Institute for Health and Care Excellence (NICE). Acute heart failure quality
standard, published December 2015. https://www.nice.org.uk/guidance/qs103/chapter/Quality-statement-6-Followup-clinical-assessment. Accessed September 14, 2017.
Komajda M et al. Eur J Heart Fail. 2016;18:1182-89.
Cowie MR et al. Int J Clin Pract. 2012;66:728-30.
Böhm M et al. Eur J Heart Fail. 2017.
Cowie MR et al. Int J Cardiol. 2017;236:340-4.
Bohm M et al. Am J Cardiol. 2015;116:1890-97.
Tavazzi L et al. Int J Cardiol. 2013:170:182-8.
Voors AA et al. Eur J Heart Fail. 2014;16:426-34.
Komajda M et al. Eur J Heart Fail. 2015:17:1294-301.
https://www.nice.org.uk/guidance/qs103/chapter/Quality-Statement-6-Followup-clinical-assessment https://www.nice.org.uk/guidance/qs103/chapter/Quality-Statement-6-Followup-clinical-assessment
Table of Contents for the Digital Edition of ESC Congress 2017 In Review -- Main Edition
