Medical Therapy For Heart Failure Research Articles

New heart failure guidelines offer a changing landscape

New heart failure guidelines offer a changing landscape

Application of recommended therapies among patients with heart failure during the Syrian conflict: reality and barriers.

Lower socio-economic status may delay and even prevent the application of guideline-directed heart failure (HF) therapy for most patients. This study aims to evaluate the feasibility and possible difficulties facing the application of this treatment during the current Syrian conflict. A questionnaire on HF management and feasibility of recommended HF therapy was addressed to physicians practising cardiology in Syria. The questionnaire consisted of 30 questions and focused on the quality of HF management and awareness of recommended drug and device therapy for HF among physicians practising cardiology in Syria. A total of 228 physicians participated in the survey. Awareness of recommended medical and device therapy of HF was very high among participants (98% and 95%, respectively). The majority of participants (>75%) believe that more than half of HF patients do not receive optimal medical HF therapy. Ninety per cent of participants believe that <10% of patients with an appropriate indication for device therapy receive it. More than 75% of participants believe that the cost of medications, alone or in combination with other medical causes, represents the major problem facing the application of optimal HF medical therapy. More than 95% of participants reported that cost alone, or in combination with unavailability, is the primary reason why patients with appropriate indications are not offered device therapy. Despite the high level of awareness of recommended HF therapies among Syrian cardiologists, the majority of HF patients are still undertreated. Financial difficulties and lack of resources are the main causes of this problem.

Early Clinical Experience with Dapagliflozin in Children with Heart Failure.

Pediatric heart failure (HF) is associated with significant morbidity and mortality. Medical treatment for pediatric HF is largely derived from adult studies. Previously, there has been no described use of dapagliflozin in pediatric HF patients. We describe our single-center experience using dapagliflozin in addition to standard HF medical therapy in 38 pediatric HF patients since January 2020. Median age was 12.2years (interquartile range 6.2-17.5). Majority of patients had dilated cardiomyopathy (68.4%) and reduced left ventricular ejection fraction (LVEF) of 40% or less (65.8%). HF regimens commonly included sacubitril/valsartan, beta-blocker, mineralocorticoid receptor antagonist, and loop diuretic. Median follow-up from dapagliflozin initiation for the whole cohort was 130days (IQR 76-332). Median B-type natriuretic peptide decreased significantly from 222 to 166pg/mL at latest clinical follow-up (P = .04). Estimated glomerular filtration rate trended lower at latest follow-up but was not significant from baseline. There were no clinically significant changes in blood chemistries or vital signs after initiation of dapagliflozin. No patients experienced symptomatic hypoglycemia or hypovolemia. Six patients (15.8%) experienced a symptomatic urinary tract infection necessitating antibiotic treatment. In a separate analysis of 16 patients with dilated cardiomyopathy who received dapagliflozin for a median of 313days (IQR 191-414), median LVEF increased significantly from 32 to 37.2% (P = .006). Dapagliflozin, when added to a background of guideline-directed medical therapy, appears well tolerated in children with HF. Larger studies are needed to evaluate safety and efficacy of dapagliflozin in this population.

The Association of Digital Health Application Use With Heart Failure Care and Outcomes: Insights From CONNECT-HF

It is unknown whether digital applications can improve guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF). Care Optimization Through Patient and Hospital Engagement Clinical Trial for Heart Failure trial (CONNECT-HF) included an optional, prospective ancillary study of a mobile health application among patients hospitalized due to HFrEF. Digital users were matched to nonusers from the usual-care group. Coprimary outcomes included change in opportunity-based composite HF quality scores and HF rehospitalization or all-cause mortality. Among 2431 patients offered digital applications across the United States, 1526 (63%) had limited digital access or insufficient data, 425 (17%) were digital users, and 480 (20%) declined use. Digital users were similar in age to those who declined use (mean 58 vs 60 years; P = 0.031). Digital users (n = 368) vs matched nonusers (n = 368) had improved composite HF quality scores (48.0% vs 43.6%; + 4.76% [3.27-6.24]; P = 0.001) and composite clinical outcomes (33.0% vs 39.6%; HR 0.76 [0.59-0.97]; P = 0.027). Among participants in the CONNECT-HF trial, use of digital applications was modest but was associated with higher HF quality-of-care scores, including use of GDMT and better clinical outcomes. Although cause and effect cannot be determined from this study, the application of technology to guide GDMT use and dosing among patients with HFrEF warrants further investigation.

Effects of guideline-directed medical therapy in patients with left bundle branch block-induced cardiomyopathy

Introduction and objectivesLeft bundle branch block (LBBB)-induced cardiomyopathy occurs in patients with long-standing LBBB. These patients characteristically exhibit hyperresponsiveness to cardiac resynchronization therapies (CRT). However, there is scarce information on their response to medical treatment. The aim of this study was to assess the change in left ventricular ejection fraction (LVEF) after a 3-month period following titration of guideline-directed medical therapy for heart failure. MethodsThis retrospective analysis included all patients assessed in the heart failure unit of a Spanish University Hospital between 2020 and 2021, who presented with de novo ventricular dysfunction (LVEF <40%) and had a history of long-standing LBBB with no other possible causes of cardiomyopathy. ResultsA total of 1497 patients were analyzed, of which 21 were finally eligible. Mean time from first diagnosis of LBBB to first consultation was 4.05± 4.1 years. Mean LVEF from first consultation to end of titration improved from 29.5±5.7% to 32.7±8.6% (P = .172), but none had recovered ventricular function at the end of follow-up. New York Heart Association functional class improved from 1.91±0.46 to 1.81±0.53 (P=.542). After CRT device implantation in 8 patients, LVEF improved by 18.1±6.4% (P=.003). ConclusionsGuideline-directed medical therapy seems to be ineffective in improving LVEF and functional class in patients with de novo heart failure and LBBB-induced cardiomyopathy. Based on a positive response to CRT on LVEF improvement, early CRT implantation could be a reasonable strategy for these patients.

Medical therapy for heart failure with preserved ejection fraction: Still a minefield, but with new hope

Medical therapy for heart failure with preserved ejection fraction: Still a minefield, but with new hope

Proposal for an Ambulatory Heart Failure Management Curriculum for Cardiology Residency Training Programs

BackgroundThe suboptimal implementation of guideline-directed medical therapy (GDMT) for heart failure (HF) patients has been linked with poor clinical outcomes. Little is known about the potential role of cardiology residency training programs in improving trainees’ (ie, future cardiologists’) ability to utilize GDMT. MethodsIn this survey-based study, we examined the degree of exposure to ambulatory HF patient management among cardiology trainees in Canada. All cardiology residency program directors (n = 15; 100% response rate) completed our survey. ResultsAlthough 9 programs (60%) mandated ≥ 3 ambulatory cardiology rotations, only 3 (20%) required ≥ 2 ambulatory HF rotations. When HF rotations were provided, only 7 programs (47%) offered moderate or higher exposure to ambulatory nontransplant HF patients (defined as ≥ 5 clinics/rotations). This element was independent of program- and institution-specific characteristics. All institutions had a multidisciplinary HF clinic, and the majority (13 [87%]) had access to an inpatient HF service, a consultative HF service, and/or a specialist pharmacist. Furthermore, 13 program directors (87%) agreed on the importance of adopting HF training curriculum and their program’s readiness to implement such a module. ConclusionsThe current state of HF training among cardiology residencies is suboptimal and in need of improvement. Most programs have access to a HF clinic, a specialist pharmacist, or an inpatient consultative service, which would facilitate adoption of a HF management curriculum that focuses on practical and experiential aspects of GDMT optimization. This program, which is under development, will be offered to training programs nationwide, to enable trainees to manage this growing and increasingly complex patient population.

Electronic Health Record-Based Deep Learning Prediction of Death or Severe Decompensation in Heart Failure Patients

BackgroundSurgical mechanical ventricular assistance and cardiac replacement therapies, although life-saving in many heart failure (HF) patients, remain high-risk. Despite this, the difficulty in timely identification of medical therapy nonresponders and the dire consequences of nonresponse have fueled early, less selective surgical referral. Patients who would have ultimately responded to medical therapy are therefore subjected to the risk and life disruption of surgical therapy. ObjectivesThe purpose of this study was to develop deep learning models based upon commonly-available electronic health record (EHR) variables to assist clinicians in the timely and accurate identification of HF medical therapy nonresponders. MethodsThe study cohort consisted of all patients (age 18 to 90 years) admitted to a single tertiary care institution from January 2009 through December 2018, with International Classification of Disease HF diagnostic coding. Ensemble deep learning models employing time-series and densely-connected networks were developed from standard EHR data. The positive class included all observations resulting in severe progression (death from any cause or referral for HF surgical intervention) within 1 year. ResultsA total of 79,850 distinct admissions from 52,265 HF patients met observation criteria and contributed >350 million EHR datapoints for model training, validation, and testing. A total of 20% of model observations fit positive class criteria. The model C-statistic was 0.91. ConclusionsThe demonstrated accuracy of EHR-based deep learning model prediction of 1-year all-cause death or referral for HF surgical therapy supports clinical relevance. EHR-based deep learning models have considerable potential to assist HF clinicians in improving the application of advanced HF surgical therapy in medical therapy nonresponders.

In-hospital Initiation and Up-titration of Guideline-directed Medical Therapies for Heart Failure with Reduced Ejection Fraction.

Implementation of guideline-directed medical therapy for patients with heart failure is suboptimal. The use of guideline-directed medical therapy improves minimally after heart failure hospitalisation, despite this event clearly indicating increased risk of further hospitalisation and death. In-hospital initiation and titration of guideline-directed medical therapies is one potential strategy to fill these gaps in care, both in the acute vulnerable period after hospital discharge and in the long term. The purpose of this article is to review the knowledge gaps in best practices of in-hospital initiation and up-titration of guideline-directed medical therapies, the benefits and risks of in-hospital initiation and post-discharge focused titration of guideline-directed medical therapies, the recent literature evaluating these practices, and propose strategies to apply these principles to the care of patients with heart failure with reduced ejection fraction.

Role of Implantable Cardioverter Defibrillator in Heart Failure With Contemporary Medical Therapy.

Implantable cardioverter defibrillator therapy is indicated in a subset of patients with heart failure with reduced ejection as primary prevention for sudden cardiac death. The advent of novel medical therapies including mineralocorticoid receptor antagonists, angiotensin receptor blocker/neprilysin inhibitors, and sodium-glucose transporter 2 inhibitor in the past 2 decades has revolutionized heart failure with reduced ejection management. Current guideline-directed medical therapy has reduced all-cause mortality and sudden cardiac death and confers a considerable improvement in left ventricular ejection fraction over a short period of time. However, there is limited evidence at present to suggest whether implantable cardioverter defibrillator therapy continues to have the same benefit in sudden cardiac death prevention at current left ventricular ejection fraction cutoff indications for patients on contemporary guideline-directed medical therapy for heart failure with reduced ejection. In this review, the authors propose in lieu of current evidence that it is reasonable to reevaluate indications for implantable cardioverter defibrillator therapy in patients on contemporary guideline-directed medical therapy for heart failure with reduced ejection.

Polypharmacy in Older Heart Failure Patients: a Multidisciplinary Approach.

We provide a review of considerations when applying principles of optimal pharmacotherapy to older adults with heart failure (HF), an analysis on the pivotal clinical trials focusing on applicability to older adults, and multi-disciplinary strategies to optimize the health of HF patients with polypharmacy. Polypharmacy is very common among patients with HF, due to medications for both HF and non-HF comorbidities. Definitions of polypharmacy were not developed specifically for older adults with HF and may need to be modified in order to meaningfully describe medication burden and promote appropriate medical therapy. This is because clinical practice guidelines for multi-drug HF regimens have unique considerations, given that they improve outcomes and symptoms of HF. Adults older than 65years are well represented in contemporary clinical trials for HF with preserved ejection fraction (HFpEF) and guideline directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF). While these trials did not have significant heterogeneity in safety or efficacy across a broad age spectrum, some may have limited representation of adults ≥ 80years old, the sickest older adults, or those with decreased functional status. There is also a lack of data on the safety and efficacy of deprescribing HF medications, and deprescription in otherwise stable patients may lead to clinical destabilization or disease progression. There is therefore innate tension between the well-studied benefits of optimized HF therapy for older adults that must be weighed against the risks of polypharmacy and many unknowns that still exist. Given the strong evidence that optimized HF therapies confer symptomatic and mortality benefits for older adults, it is clear that polypharmacy in this context can be appropriate. A shift in paradigm is therefore needed when evaluating polypharmacy in patients with HF. Instead of assuming all polypharmacy is "good" or "bad," we propose a concerted move, using a multidisciplinary approach, to focus on the "appropriateness" of specific medications, in order to optimize HF medical therapy. Clinicians of all specialties caring for complex older adults with HF must consider goals of care, functional status, and new evidence-based therapies, in order to optimize this polypharmacy for older adults.

Can We Stop Reflexively Discontinuing Mineralocorticoid Antagonists for Patients With Heart Failure and Hyperkalemia?

The importance of promptly introducing low doses of multiple classes of guideline-directed medical therapy (GDMT) in patients with symptomatic heart failure is underscored in the recent heart failure guidelines. 1 Heidenreich PA Bozkurt B Aguilar D et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. J Card Fail. 2022; 28: e1-e167https://doi.org/10.1016/j.cardfail.2022.02.010 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Concerns purported to foster the underuse of GDMT include inadequate patient and laboratory follow-up, patient nonadherence, medication-related expenses, polypharmacy, and the perceived risk of hyperkalemia (Fig. 1). 2 Greene SJ Butler J Albert NM et al. Medical therapy for heart failure with reduced ejection fraction. J Am Coll Cardiol. 2018; 72: 351-366https://doi.org/10.1016/j.jacc.2018.04.070 Crossref PubMed Scopus (412) Google Scholar Such trepidations commonly lead to avoidance or premature discontinuation of mineralocorticoid antagonists (MRAs). Observational data show that a single episode of hyperkalemia is cited as justification for cessation of MRAs in approximately 30% of patients; severe hyperkalemia (K+ ≥ 6 mmol/L) occurs in only one-quarter of those patients, but is commonly labeled as medication intolerance. 3 Trevisan M Fu EL Xu Y et al. Stopping mineralocorticoid receptor antagonists after hyperkalaemia: trial emulation in data from routine care. Eur J Heart Fail. 2021; 23: 1698-1707https://doi.org/10.1002/ejhf.2287 Crossref PubMed Scopus (10) Google Scholar MRA discontinuation decreases the incidence of recurrent hyperkalemia but confers a 10%–30% increased downstream risk of mortality and cardiovascular events. 3 Trevisan M Fu EL Xu Y et al. Stopping mineralocorticoid receptor antagonists after hyperkalaemia: trial emulation in data from routine care. Eur J Heart Fail. 2021; 23: 1698-1707https://doi.org/10.1002/ejhf.2287 Crossref PubMed Scopus (10) Google Scholar ,4 Siddiqi Tariq J Usman Muhammad S Abid M et al. Is stopping mineralocorticoid receptor antagonists after hyperkalemia associated with increased mortality in heart failure? A systematic review and meta-analysis. J Am Coll Cardiol. 2022; 79: 406https://doi.org/10.1016/S0735-1097(22)01397-3 Crossref Google Scholar Thus, patients are frequently deprived of life-saving therapies owing to hyperkalemia concerns. In this article, we present evidence supporting MRA continuation in the setting of mild hyperkalemia, suggest mitigation strategies and interventions for moderate to severe hyperkalemia, and expand on new and future options that may help attenuate the overall risk of hyperkalemia and its complications.

Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair

ObjectiveA sizeable proportion of patients with secondary mitral regurgitation (SMR) do not receive guideline-directed medical therapy (GDMT) for heart failure (HF). We investigated the association between the use of GDMT...

The impact of sleep disordered breathing on cardiac troponin in acutely decompensated heart failure

PurposeSleep disordered breathing in decompensated heart failure has physiological consequences (e.g., intermittent hypoxemia) that may predispose to subclinical myocardial injury, yet a temporal relationship between sleep apnea and troponin elevation has not been established.MethodsWe assessed the feasibility of performing respiratory polygraphy and measuring overnight high-sensitivity cardiac troponin T change in adults admitted to the hospital with acutely decompensated heart failure. Repeat sleep apnea tests (SATs) were performed to determine response to optimal medical heart failure therapy. Multivariable logistic regression was used to identify associations between absolute overnight troponin change and sleep apnea characteristics.ResultsAmong the 19 subjects with acutely decompensated heart failure, 92% of SATs demonstrated sleep disordered breathing (apnea–hypopnea index [AHI] > 5 events/h). For those with repeat SATs, AHI increased in 67% despite medical management of heart failure. Overnight troponin increase was associated with moderate to severe sleep apnea (vs. no to mild sleep apnea, odds ratio (OR = 18.4 [1.51–224.18]), central apnea index (OR = 1.11 [1.01–1.22]), and predominantly central sleep apnea (vs. obstructive, OR = 22.9 [1.29–406.32]).ConclusionsSleep apnea severity and a central apnea pattern may be associated with myocardial injury. Respiratory polygraphy with serial biomarker assessment is feasible in this population, and combining this approach with interventions (e.g., positive airway pressure) may help establish if a link exists between sleep apnea and subclinical myocardial injury.

The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta-analysis of COMPANION and CARE-HF.

AimsCardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. The aim of this study was to identify patient characteristics that predict the effect, specifically, of CRT pacemakers (CRT‐P) on all‐cause mortality or the composite of hospitalization for heart failure or all‐cause mortality.Methods and resultsWe conducted an individual patient data meta‐analysis of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) and Cardiac Resynchronization‐Heart Failure (CARE‐HF) trials. Only patients assigned to CRT‐P or control (n = 1738) were included in order to avoid confounding from concomitant defibrillator therapy. The influence of baseline characteristics on treatment effects was investigated. Median age was 67 (59–73) years, most patients were men (70%), 68% had a QRS duration of 150–199 ms and 80% had left bundle branch block. Patients assigned to CRT‐P had lower rates for all‐cause mortality (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.56–0.81; p < 0.0001) and the composite outcome (HR 0.67, 95% CI 0.58–0.78; p < 0.0001). No pre‐specified characteristic, including sex, aetiology of ventricular dysfunction, QRS duration (within the studied range) or morphology or PR interval significantly influenced the effect of CRT‐P on all‐cause mortality or the composite outcome. However, CRT‐P had a greater effect on the composite outcome for patients with lower body surface area and those prescribed beta‐blockers.ConclusionsCardiac resynchronization therapy‐pacemaker reduces morbidity and mortality in appropriately selected patients with heart failure. Benefits may be greater in smaller patients and in those receiving beta‐blockers. Neither QRS duration nor morphology independently predicted the benefit of CRT‐P.Clinical Trial Registration: COMPANION, NCT00180258; CARE‐HF, NCT00170300.

P222 BENEFITS OF IVRABRADINE IN HEART FAILURE: FROM TRIALS TO CLINICAL PRACTICE

Abstract The incidence and prevalence of heart failure (HF) are constantly increasing and represent a fundamental problem for patient hospitalizations and the resulting healthcare costs. In the latest European guidelines the importance of therapeutic optimization in patients suffering from (SCC) has been emphasized to improve prognosis. This was confirmed by the results of the SHIFT trial, aimed at establishing the efficacy of Ivabradine in addition to therapy for the SC. The SHIFT study was performed in symptomatic HF patients with left ventricular systolic dysfunction. Patients were in NYHA class between II and IV and with at least one HF exacerbation hospitalization in the previous year, were randomized to receive Ivabradine at an initial dose of 5 mg twice a day. All patients were treated at the optimal dose of therapy, with ACE–I or Sartani (90%), BB (90%) and MRA (60%). The average follow–up was 24 months. Patients who received ivabradine showed a significant 20% reduction in hospitalization for heart failure exacerbation. These results were also confirmed by the improvement of the clinical picture based on the NYHA classification and the ejection fraction. Also in our clinical practice we found the same result: 6 patients of average age (70–75 years), suffering from HF with severe left ventricular systolic dysfunction (NHYA III), and arterial hypertension in standard therapy optimal for HF according to LG, reach outpatient evaluation for clinical and instrumental follow–up. On check–up, they have dilated heart disease with severe left ventricular systolic dysfunction (FE 35–38%) on the echocardiogram. Therapy with Ivabradine 5 mg x 2 / day was introduced. Upon clinical re–evaluation, after 6 months of therapy, an improvement in the functional class of SC (from NYHA III to NYHA II) and in the ejection fraction (from 38% to 45%) was noted. Conclusions Ivabradine, together with optimal medical therapy for HF, reduced hospitalizations for HF, increased survival and improved patient symptoms, reducing left ventricular remodeling, as confirmed by our clinical practice. Therefore, therapy with Ivabradine, in combination with Beta–Blockers or alone, constitutes a rational and synergistic therapeutic choice for improving the prognosis and quality of life in patients with SCC.

Medical Therapies for Heart Failure in Hypoplastic Left Heart Syndrome.

Significant surgical and medical advances over the past several decades have resulted in a growing number of infants and children surviving with hypoplastic left heart syndrome (HLHS) and other congenital heart defects associated with a single systemic right ventricle (RV). However, cardiac dysfunction and ultimately heart failure (HF) remain the most common cause of death and indication for transplantation in this population. Moreover, while early recognition and treatment of single ventricle-related complications are essential to improving outcomes, there are no proven therapeutic strategies for single systemic RV HF in the pediatric population. Importantly, prototypical adult HF therapies have been relatively ineffective in mitigating the need for cardiac transplantation in HLHS, likely due to several unique attributes of the failing HLHS myocardium. Here, we discuss the most commonly used medical therapies for the treatment of HF symptoms in HLHS and other single systemic RV patients. Additionally, we provide an overview of potential novel therapies for systemic ventricular failure in the HLHS and related populations based on fundamental science, pre-clinical, clinical, and observational studies in the current literature.

The use of multidisciplinary teams, electronic health records tools, and technology to optimize heart failure population health.

Given the limited population level, adoption of optimal therapy that has been shown in recent clinical trials and heart failure registries, efforts to rapidly and safely improve adoption of guideline-directed medical therapy for heart failure should be prioritized. Opportunities to leverage remote monitoring technology, the electronic health record (EHR), and multidisciplinary teams to improve heart failure care merit review. Dedicated multidisciplinary teams employing algorithmic medication titration schema have shown better efficacy than clinician alerts or quality initiatives that focus on education and audit-feedback processes alone. Technology that enables invasive pressure monitoring and wearable devices that transmit physiologic data have the potential to predict decompensation and allow for early intervention by alerting clinicians to signs of congestion/clinical worsening but further real-world data is needed to prove efficacy and develop effective treatment protocols. The combination of technology, multidisciplinary teams, and identification of populations for intervention using the EHR will be central to impactful innovation in heart failure population health and prevention of avoidable morbidity. Novel approaches to study implementation efforts including cluster randomized trials are needed.

Contemporary review of heart transplant immunology and immunosuppressive therapy

Background Survival after heart transplantation (HT) has improved considerably since the first HT was performed in 1967 in Cape Town, South Africa. Understanding immunology behind organ rejection has paved way for advances in the assessment of pre-transplant compatibility, development of newer and more specific immunosuppressive drugs, and management of rejection. Objectives Unlike medical therapy for heart failure, transplant protocols vary considerably between different centers. These variations in protocols generally reflect unique population characteristics and the availability of resources. This review article aims to provide a consolidated update on contemporary cardiac transplant medicine. We also aim to highlight local practice and its difference from our international counterparts. Methods A literature search was performed on Pubmed and Cochrane Central Register of Controlled Trials to identify trials and review articles that discussed heart transplant immunology and protocols. The International Society for Heart and Lung Transplant (ISHLT) guidelines were also reviewed. We focused on risk factors, prevention strategies, and treatment of cardiac rejection. Results A total of 48 articles were selected to provide a comprehensive overview of the contemporary practice of cardiac transplant immunosuppressive therapy. Comparisons were made with local data and practice protocols to highlight key differences. Conclusion Heart transplant covers a small subset of cardiac patients and much of the evidence is derived from empirical observations and retrospective analysis. This accounts for the heterogeneity in care and treatment protocols. More studies are needed to select best practices from around the world to further improve outcomes.

Abstract 85: Evaluation Of Guideline-Directed Medical Therapy Prescribing In Patients Undergoing Transcatheter Edge-to-Edge Repair

Background: The benefits of guideline-directed medical therapy (GDMT) in heart failure (HF) are well established, but the optimization of GDMT prior to and following transcatheter edge-to-edge repair (TEER) remains understudied. The purpose of this study was to evaluate GDMT use pre-and post-TEER. Methods: We performed a retrospective analysis of the electronic health records from 2019 to 2021 at the University of Illinois at Chicago of patients that underwent TEER. Patients were included if they had follow-up records within 6 months and a baseline ejection fraction (EF) &lt; 50%. Demographic information, vitals, labs, and pertinent echocardiogram information were obtained at baseline and 6 months. GDMT doses were collected at baseline, discharge, 30 days, 3, and 6 months. Results: In total, 20 patients were included: 15 were male (75%) and 19 were non-white (95%). The average age was 66.8 years old (range 32.8-86.5). Past medical history was significant for 19 with hypertension (95%) and 15 with hyperlipidemia, coronary artery disease, and smoking history, respectively (75%). Pre-procedure mean blood pressure and heart rate were 123/74 mmHg and 81 bpm. Average creatinine was 1.66 ± 0.94 mg/dL and 1.10 ± 0.97 mg/dL at baseline and 6 months, respectively. A total of 9 patients (45%) had functional mitral regurgitation, 11 (65%) had primary or degenerative mitral regurgitation. A total of 6 patients (30%) had 11 readmissions for acute decompensated HF, 2 patients died, and 1 patient’s EF improved to &gt; 50% by 6 months. GDMT is described in Table 1. No patients were prescribed SGLT2 inhibitors. Conclusion: GDMT for patients pre-and post-TEER procedure is neither prescribed nor titrated effectively. Further investigation will focus on confounding factors affecting prescribing patterns and titrations. Our findings demonstrate a continued opportunity for quality improvement in GDMT optimization during TEER hospital admission and follow-up visits.