Chapter 3: Heart Failure: Evidence Review and Management 2 Contact Hours
By: Shyam Gelot, PharmD, BCPS Author Disclosure : Shyam Gelot and Colibri Healthcare, LLC do not have any actual or potential conflicts of interest in relation to this lesson. Universal Activity Number (UAN) : 0607-0000-22-017-H01-P Activity Type : Knowledge-based Initial Release Date : August 10, 2022 Expiration Date : August 10, 2025 Target Audience: Pharmacists in a community-based setting. To Obtain Credit: A minimum test score of 75 percent is needed to obtain a credit. Please submit your answers either by mail, fax, or online at EliteLearning.com/Book Questions regarding statements of credit and other customer ser- vice issues should be directed to 1-888-666-9053. This lesson is $14.95. Learning objectives After reading this monograph, pharmacists should be able to: Understand the etiology, classification, and symptoms of heart failure. Introduction AHeart failure is a complex clinical syndrome associated with in- creasingly high hospitalization, readmission, and mortality rates. After the initial hospital admission, five-year mortality rates for patients with heart failure may be as high as 75% (Shah et al., 2017). Alarmingly, 25% of patients with heart failure require read- mission to the hospital within 30 days of discharge, and 25% of all these cases are preventable (Khan et al., 2021). According to the CHAMP-HF registry, of all eligible patients with heart failure, over 25% were not prescribed a guideline-based medication with prov-
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Describe the pathophysiology of heart failure. Evaluate evidence-based pharmacotherapy options for heart failure with reduced and preserved ejection fraction.
en ability to reduce mortality. Furthermore, less than 30% of these patients received the appropriate targeted doses of these core heart failure medications (Greene et al., 2018). Healthcare provid- ers have an essential role in improving heart failure outcomes by bridging the gap between guideline-directed recommendations and actual clinical practice. A complete understanding of risk fac- tors, comorbid conditions, pathophysiology, and current pharma- cotherapeutic options can help clinicians to reduce the economic and disease burden associated with this syndrome.
BACKGROUND
Epidemiology Heart failure (HF) is a condition that affects over 6 million adults in the United States, and approximately 960,000 new cases of HF are diagnosed each year (Benjamin et al., 2017; Virani et al., 2021). While concerning, HF’s true incidence and prevalence may be even higher due to undiagnosed cases and a lag in current statistics derived from retrospective epidemiologic data. Despite advances in the medical field, the prevalence of HF is estimated to increase to more than 8 million adults in the United States by the year 2030 (Benjamin et al., 2017). The socioeconomic burden of HF, which includes costs of medica- tions, healthcare services, and work productivity, was estimated at $30.7 billion per year a decade ago (Benjamin et al., 2019). However, with the growing prevalence of HF, this figure increased in 2020 to $43.6 billion and may reach $69.7 billion per annum by 2030 (Urbich et al., 2020). Certain inherent characteristics can increase the risk of HF, such as age, sex, and ethnicity. Heart failure is common with advanc- ing age, where 80% of HF-related hospitalizations occur in those 65 years of age and older (Lesyuk et al., 2018). By the year 2030, the prevalence of HF could be as high as 8.5% amongst those 65 to70 years of age (Van Nuys et al., 2018). The lifetime risk of HF is similar regarding gender; however, the prevalence of dia- stolic heart failure remains two times greater in women (Lam et al., 2019; Schwinger, 2021). Furthermore, disparities in HF exist with
specific ethnic groups; African Americans have a higher incidence and prevalence of HF than Caucasians, and African American females have the highest prevalence of HF of all demographics (Virani et al., 2020). Compared with Caucasians, African Ameri- cans also have a 2.5-fold higher rate of HF-related hospitalizations (Nayak et al., 2020). In addition to the growing prevalence, HF is associated with high morbidity and mortality rates after symptom onset. In 2018, HF was listed on 13.4% (n= 379,800) of all death certificates (CDC, 2020). Given the numerous factors contributing to HF mortality, the data regarding mortality are conflicting; however, when evalu - ating long-term studies that use standardized criteria, the 5-year mortality rate is estimated at 50% (Roger, 2021). Additionally, un- controlled comorbidities associated with HF can lead to mortality, hospitalization, and poor quality of life. Greater than half of all pa- tients with HF have comorbid conditions, which may include: ane- mia, chronic kidney disease, diabetes, hypertension (HTN), and atrial fibrillation (Khan et al., 2020). Careful attention for treating comorbidities is imperative for clinical providers because certain medications may increase HF risk. For example, certain type 2 diabetes mellitus (T2DM) medications (e.g., pioglitazone and sax- agliptin) may increase the risk of HF development and HF-related hospitalizations.
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