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Initial experience of a nursing consultation in the uptitration of neurohumoral treatment in patientes with heart failure and reduced ejection fraction

Session Poster Session 2

Speaker Vanessa Escolar Perez

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : V Escolar Perez (Bilbao,ES), A Lozano (Bilbao,ES), A Echebarria (Bilbao,ES), A Azcona (Bilbao,ES)

Authors:
V Escolar Perez1 , A Lozano1 , A Echebarria1 , A Azcona1 , 1Hospital de Basurto, Cardiology - Bilbao - Spain ,

Citation:

Introduction
- Nursing is a cornerstone for the follow-up of patients with HF, carrying out important educational work, follow-up (including telemedicine projects) and, more recently, in the up titration of drugs with prognostic impact.
- Recently the HF Unit of our hospital has incorporated HF nursing in the up titration of drugs.

Objectives and methods
- The objective is to describe the characteristics of the patients referred to the nurse's consultation, the treatment that the patients were prescribed at the first visit and the treatment achieved.
- We collected patient data from the implementation of the nursing consultation in November 2017 until September 2018.
- The up titration was carried out following a protocol drawn up by the unit's professionals, in which consultations are carried out every 2 weeks with ECG and blood analysis and a progressive increase in drug doses.

Results
- Twenty-six patients (21 men and 5 women) with an average age of 60.7 years (SD 13.1) were included. The most prevalent heart disease is ischemic (46.2%), followed by idiopathic (42.3%). The mean LVEF is 27.4 (SD 7.8). 15 patients are in sinus rhythm and 2 in atrial fibrillation.
- Figure 1 describes the characteristics of the pharmacological treatment of the patients in the first nurse's consultation and upon completion of titration. High dose of beta-blocker was reached in 54% of patients and high dose of ACEI-ARA-ARNI in 84%. The reason for not achieving higher doses of beta-blocker was sinus bradycardia. In patients who did not reach the maximum dose of ACEi-ARA, it was due to symptomatic hypotension.
- In patients in whom the titration has been completed, the time invested was 9.4 weeks (SD 5.2). During this phase there were no HF decompensations requiring emergency visits or hospital admissions.

Conclusions
- Drug titration is possible in patients with HF and reduced LVEF, and maximum doses can be safely reached in most cases.

Beginning

End

p

SBP (mmHg)

124,5 (18,4)

117,2 (18,0

0,043

DBP (mmHg)

78,6 (10,9)

75,9 (9,2

0,039

HR (bpm)

70,2 (13,6)

62,9 (8,5

0,004

Comparison of hemodynamic values before and after titration. *HR only in patients in sinus rhythm

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