Velasco Claudia Mae, Baksh Gladys, Haydo Michele, Reesor Heather, Boehmer John, Ali Omaima
Penn State College of Medicine, Hershey, Pennsylvania, USA.
Division of Cardiology, Heart & Vascular Institute, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
Clin Cardiol. 2025 Jul;48(7):e70179. doi: 10.1002/clc.70179.
Utilization of heart failure (HF) guideline-directed medical therapy (GDMT) to target doses is suboptimal, with studies citing adverse effects (AEs), physiological factors, and therapeutic inertia as potential contributing factors. The objective of our study was to explore tolerability and GDMT titration-limiting AEs in a specialized heart failure optimization program implemented at our institution.
We studied the baseline characteristics of 254 patients who successfully completed our program and analyzed the frequency and severity of the four most common GDMT-related AEs: hypotension, bradycardia, hyperkalemia, and renal dysfunction.
Patients who achieved target doses were younger, more likely to have nonischemic HF, less likely to have a recent HF-related hospitalization, had less coronary artery disease, and were more likely to be obese. Multivariate analyses revealed significant associations between beta blocker suboptimal dosing (< 50% of target dose) and older age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.0-1.07; p = 0.031), presence of atrial fibrillation (OR: 2.57; 95% CI: 1.18-5.58; p = 0.017), and absence of hypertension (OR: 0.39; 95% CI: 0.17-0.89; p = 0.025). For angiotensin converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor neprilysin inhibitors, suboptimal dosing was associated with the presence of atrial fibrillation (OR: 2.08; 95% CI: 1.04-4.17; p = 0.039). Of the patients who completed the program, 59.1% encountered at least one AE that hindered the titration to target GDMT doses.
Our findings highlight the complexities of GDMT optimization within a specialized program and the need for standardized definitions of GDMT-related AEs and management strategies.
心力衰竭（HF）指南指导的药物治疗（GDMT）达到目标剂量的情况并不理想，研究指出不良反应（AE）、生理因素和治疗惰性是潜在的影响因素。我们研究的目的是在我们机构实施的一个专门的心力衰竭优化项目中探索耐受性以及限制GDMT滴定的AE。
我们研究了254名成功完成我们项目的患者的基线特征，并分析了四种最常见的与GDMT相关的AE的发生频率和严重程度：低血压、心动过缓、高钾血症和肾功能不全。
达到目标剂量的患者更年轻，更有可能患有非缺血性HF，近期因HF住院的可能性更小，冠状动脉疾病更少，且更有可能肥胖。多变量分析显示，β受体阻滞剂剂量未达最佳（<目标剂量的50%）与年龄较大（比值比[OR]：1.04；95%置信区间[CI]：1.0 - 1.07；p = 0.031）、存在心房颤动（OR：2.57；95% CI：1.18 - 5.58；p = 0.017）以及无高血压（OR：0.39；95% CI：0.17 - 0.89；p = 0.025）之间存在显著关联。对于血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂，剂量未达最佳与存在心房颤动相关（OR：2.08；95% CI：1.04 - 4.17；p = 0.039）。在完成该项目的患者中，59.1%至少遇到过一种阻碍滴定至目标GDMT剂量的AE。
我们的研究结果凸显了在一个专门项目中进行GDMT优化的复杂性，以及对与GDMT相关的AE进行标准化定义和管理策略的必要性。
