New Study Published in JACC: Heart Failure Reveals that Despite Significant Efforts to Improve Acute Heart Failure Treatment Over the Past 20 Years, Management Remains Unchanged
2024年5月2日 - 9:00PM
ビジネスワイヤ(英語)
-- Reprieve Cardiovascular Partners with
Leading Heart Failure Researchers and Truveta to Analyze Real-World
Heart Failure Patient Data to Highlight Opportunities to Improve
the Current Patient Management Paradigm --
Reprieve Cardiovascular, Inc. (‘Reprieve’), a development stage
company focused on pioneering an intelligent approach to acute
decompensated heart failure (ADHF) treatment, today highlighted the
publication of TREAT-AHF study results in JACC: Heart Failure.
Heart failure (HF) is a leading cause of hospitalization in the
United States. Decongestion remains a central goal of inpatient
management, but contemporary decongestion practices and associated
weight loss are not well described. Nearly 20 years ago, the Acute
Decompensated Heart Failure National Registry (ADHERE) was
published1 and described inpatient HF treatment patterns and
decongestion outcomes in a prospective national database of HF
hospitalizations across 275 community and academic medical
centers.
As a national community-based cohort, Trajectory and Response to Emergently Administered Therapy for Acute Heart Failure (TREAT-AHF) is a contemporary registry
that characterizes a diverse population of 262,673 patients with HF
from 2015 to 2022. In the TREAT-AHF study, the distribution of
inpatient body weight change was similar to those reported from
ADHERE nearly two decades ago. Discharge weight was higher than
admission weight in 20% of HF hospitalizations, highlighting the
challenges facing physicians and patients to effectively remove
excess fluid. Furthermore, there was considerable variation in
weight loss from diuretic use related to differences in patient
characteristics and clinical practices. The TREAT-AHF study also
demonstrated the median length of stay was 5.8 days (ranging from
3.7 to 9.7 days), which underscores the extended, variable duration
of inpatient decongestion treatment. This unpredictability
manifests in resource and scheduling challenges for patients,
physicians and administrators.
“Decongestion therapy is a critical part of acute heart failure
management. The TREAT-AHF analysis provides a contemporary
understanding of the state of decongestion therapy across a broad
set of health systems across the United States. We found there has
been little change in diuretic management compared with prior
cohort studies. There needs to be a call to action for developing
and testing novel strategies for improving decongestion for
patients hospitalized with heart failure,” stated Dr. Alexander
Sandhu, Division of Cardiovascular Medicine and Stanford Prevention
Research Center, Department of Medicine at Stanford University.
Additional Heart Failure Research Presented
Acute HF hospitalization represents a critical opportunity for
the rapid initiation of evidence-based medications. However, data
on GDMT use at discharge are mostly derived from national quality
improvement registries. At the American College of Cardiology 2024
scientific sessions, a TREAT-AHF subset was presented that looked
at guideline-directed medical therapy (GDMT) for heart failure with
reduced ejection fraction (HFrEF).
The study findings: Inpatient utilization of GDMT among diverse
community-based health systems was lower than rates observed in
national quality improvement registries where participation is
voluntary. Discontinuation of GDMT before discharge, contrary to
the guidelines, occurred in a substantial proportion of
hospitalizations despite previous inpatient administration.
Hypotension, hyperkalemia, and worsening renal function were strong
factors associated with discontinuation, but discontinuation was
unexplained by clinical factors in many hospitalizations.
Implementation of novel strategies to achieve comprehensive use of
GDMT is urgently needed among acute HF hospitalizations.
“Guideline-directed medical therapy underuse and discontinuation
during hospitalization for heart failure results in poor quality of
care and worse outcomes for patients. We need to develop
in-hospital management strategies including for clinical
decongestion that allow restoration of euvolemia while also
facilitating continuing and new initiation and/or up-titration of
GDMT for heart failure,” stated Dr. Andrew Ambrosy, Assistant
Medical Director for the Clinical Trials Program at the Division of
Research and a cardiologist with The Permanente Medical Group.
Advancing Acute Heart Failure Patient Management Through the
Analysis of Real-World Data
Reprieve is partnering with industry-leading heart failure
researchers and Truveta to understand and advance acute heart
failure patient outcomes. Truveta delivers the most complete,
timely, and clean electronic health record data, including images,
clinician notes, and labs from more than 30 health systems linked
with social drivers of health (SDOH), claims, and mortality data,
empowering researchers with scientifically rigorous analytics.
Truveta Data provides daily updated, regulatory-grade data from
more than 100 million de-identified patients in all 50 states from
more than 800 hospitals and 20,000 clinics to provide a timely and
representative view of patient care in the US.
Through this partnership, Reprieve is providing heart failure
researchers access to Truveta Data to facilitate the understanding
of contemporary care of patients with ADHF. The partnership with
Truveta contributed to the TREAT-AHF analysis and the publication
of the manuscripts.
“Reprieve is committed to understanding the ADHF patient
journey. The clinical evidence from the TREAT-HF study demonstrates
that heart failure decongestion management has not substantially
changed in 20 years,” said Mark Pacyna, chief executive officer of
Reprieve Cardiovascular. “The data highlights the opportunities to
improve care, but it will take a sustained partnership among
hospital systems, physicians, nurses, and industry partners to
solve this. Reprieve is committed to building these
partnerships.”
About Acute Decompensated Heart Failure
ADHF is the sudden or gradual onset of the signs or symptoms of
heart failure (difficulty breathing, leg or feet swelling, and
fatigue) requiring unplanned office visits, emergency room visits,
or hospitalization. Specifically, ADHF is caused by a rapid onset
of fluid volume overload. Five million patients a year are admitted
with heart failure diagnoses in the U.S., with 40 percent of these
patients being admitted with worsening heart failure. ADHF is one
of the leading admission diagnoses around the world. Often,
patients are re-admitted to the hospital repeatedly to treat fluid
volume overload, and each hospitalization substantially increases a
patient's morbidity and mortality.
About Reprieve Cardiovascular, Inc.
Reprieve Cardiovascular, Inc. is developing innovative and
groundbreaking therapies that aim to improve the lives of more than
25 million heart failure patients around the world. Reprieve is
bringing intelligence to decongestion management to safely
accelerate fluid removal for every heart failure patient. In 2022,
Reprieve initiated the FASTR Trial (pilot study) to compare
decongestive therapy administered by the Reprieve DMS system to
Optimal Diuretic Therapy in the treatment of patients diagnosed
with acute decompensated heart failure.
Reprieve is a privately held medical device company,
headquartered in Milford, Massachusetts, USA.
1 Adams KF., Fonarow GC., Emerman CL., et al. Characteristics
and outcomes of patients hospitalized for heart failure in the
United States: rationale, design, and preliminary observations from
the first 100,000 cases in the Acute Decompensated Heart Failure
National Registry (ADHERE). Am Heart J 2005;149(2):209–16. Doi:
10.1016/j.ahj.2004.08.005.
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