Evidence map›Paper›PMID 35663626›Full record

ReviewJACC. Basic to translational science2022

Optimizing Foundational Therapies in Patients With HFrEF: How Do We Translate These Findings Into Clinical Care?

Abhinav Sharma, Subodh Verma, Deepak L Bhatt, Kim A Connelly, Elizabeth Swiggum, Muthiah Vaduganathan, Shelley Zieroth, Javed Butler

Open access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in JACC. Basic to translational science, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
48citing papers in PubMed, 2 pooled it
13.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

48 citing papers in PubMed, 2 syntheses or guidelines pooled it, 86 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 2 countries.

Abhinav SharmaDivision of Cardiology, McGill University Health Centre, Montréal, Quebec, Canada.
Subodh VermaDivision of Cardiac Surgery, St Michael's Hospital, and Departments of Surgery, and Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
Deepak L BhattBrigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA.
Kim A ConnellyKeenan Research Center for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.
Elizabeth SwiggumDivision of Cardiology, Royal Jubilee Hospital and Department of Medicine, University of British Columbia, Victoria, British Columbia, Canada.
Muthiah VaduganathanCardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Shelley ZierothSection of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Javed ButlerDepartment of Medicine, University of Mississippi, Jackson, Mississippi, USA.
Brigham and Women's Hospital · USSt. Michael's Hospital · CAMcGill University Health Centre · CAUniversity of British Columbia · CAUniversity of Manitoba · CAUniversity of Mississippi · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Given the high risk of adverse outcomes in patients with heart failure and reduced ejection fraction (HFrEF), there is an urgent need for the initiation and titration of guideline-directed medical therapy (GDMT) that can reduce the risk of morbidity and mortality. Clinical practice guidelines are now emphasizing the need for early and rapid initiation of therapies that have cardiovascular benefit. Recognizing that there are many barriers to GDMT initiation and optimization, health care providers should aim to introduce the 4 pillars of quadruple therapy now recommended by most clinical practice guidelines: angiotensin receptor-neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors. A large proportion of patients with HFrEF do not have clinical contraindications to GDMT but are not treated with these therapies. Early initiation of low-dose combination therapy should be tolerated by most patients. However, patient-related factors such as hemodynamics, frailty, and laboratory values will need consideration for maximum tolerated GDMT. GDMT initiation in acute heart failure hospitalization represents another important avenue to improve use of GDMT. Finally, removal of therapies that do not have clear cardiovascular benefit should be considered to lower polypharmacy and reduce the risk of adverse side effects. Future prospective studies aimed at guiding optimal implementation of quadruple therapy are warranted to reduce morbidity and mortality in patients with HFrEF.

Indexed as

ACE, angiotensin-converting enzymeangiotensin receptor–neprilysin inhibitorARB, angiotensin receptor blockerARNI, angiotensin receptor neprilysin inhibitorBB, beta-blockerbeta-blockerseGFR, estimated glomerular filtration rateGDMT, guideline-directed medical therapyHF, heart failureHFrEF, heart failure with reduced ejection fractionmineralocorticoid receptor antagonistsMRA, mineralocorticoid receptor agonistSGLT2i, sodium–glucose co-transporter 2 inhibitorsodium–glucose co-transporter 2 inhibitorsT2DM, type 2 diabetes mellitus

Identifiers

PMID35663626
PMCPMC9156437
OpenAlexW4214886517

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.