Incorporating GDMT and PRO Endpoints for Personalised Heart Failure Management
Published: 23 March 2023
This series of peer-to-peer discussions examines the practicalities of personalising heart failure management in the context of recent changes to international clinical practice guidelines.
At this exciting juncture, we now have two SGLT-2 inhibitors that offer clinical benefit across the spectrum of ejection fraction, and an increasing body of real-world and registry-based data showing the clear benefit of early guideline directed medical therapy (GDMT) adoption. Further, there is a clear move towards the use of patient reported outcomes (PROs) in addition to clinical endpoints. But how can we start to incorporate these changes in current practice?
In this series, our specially selected faculty of experts consider how we can be using these recent developments to personalise our management approach to heart failure and why it matters for better long-term patient outcomes.
Key Learning Objectives
- Review current GDMT in HFrEF and HFpEF
- Describe the relationship between initiation of GDMT and HF outcomes
- Prescribe GDMT according to current international recommendations
- Recall the elements of the Kansas City Cardiomyopathy Questionnaire
- Describe the clinical studies that support the use of functional and QoL measures in practice
- Initiate QoL and functional improvement measures in routine practice
- Initiate SGLT-2 inhibitors in patients presenting with De novo HF and in patients already on other GDMT
- Adopt shared decision making with HF patients
- Heart Failure Specialists
- Primary Care Physicians
- Other allied HCPs
More from this programme
Optimising Clinical Success With Foundational Heart Failure Treatment
Prof Coats (Heart Research Institute, Sydney, AU) and Dr Kosiborod (Saint Luke’s Mid America Heart Institute, Kansas City, US) start by summarising current foundational heart failure therapy and how guidance has recently changed across the spectrum of ejection fraction. Following this, they explore recent evidence supporting initiation of GDMT and offer practical advice for the implementation of treatment, including possible solutions to the early uptake of GDMT.
Personalising Your Approach to Heart Failure Treatment
Prof Rosano (St George’s University Hospital, University of London, UK) and Dr Bozkurt (Baylor College of Medicine, Texas, US) begin by discussing how one should be initiating SGLT-2 inhibitors across the continuum of ejection fraction and across patients who are treatment naïve versus those already on existing HF medications. Referring to the recent clinical practice guidelines, Dr Bozkurt advocates the early initiation of SGLT-2 inhibitors and goes on to provide practical advice on the monitoring and continual use of these agents for better long-term outcomes.
Adopting Patient Reported Outcomes in Heart Failure Management
Dr Kosiborod (Saint Luke’s Mid America Heart Institute, US) and Dr Zieroth (St Boniface Hospital, Winnipeg, CA) discuss the adoption of PROs in clinical management of patients with HF. They start by discussing quality of life (QoL) measures and close by looking at practical implementation of tools, such as the Kansas City Cardiomyopathy Questionnaire (KCCQ), in clinical practice and HF management.
Andrew JS Coats
Professor of Cardiology and Scientific Director
Prof Coats is Editor-in-Chief of the Cardiac Failure Review journal. He has published over 20 patents, more than 750 full research papers and more than 120,000 career citations and has a personal H-index of 146. Andrew was elected to the Presidential Trio of the Heart Failure Association of the ESC in 2018 and will serve as its president from 2020-2022.
Prof Coats is the Immediate past-President of the Heart Failure Association and past-Professor of Cardiology at the University of Warwick, UK. He has also held posts as Head of Cardiology at Imperial College, London and Associate Medical Director and Director of Cardiology at the Royal Brompton and Harefield Hospitals, London. From 2012 to 2017 he was Director of the Monash-Warwick Alliance, and before that served as Deputy Vice-Chancellor and Dean of Medicine at the University of Sydney.
He is an…
Dr Mikhail Kosiborod is a cardiologist, the Vice President of Research at Saint Luke's Health System, and Professor of Medicine at the University of Missouri-Kansas City, US.
He is also Director of Cardiometabolic Research and Co-Director of the Saint Luke’s Michael & Marlys Haverty Cardiometabolic Center of Excellence at Saint Luke's Mid America Heart Institute. Dr Kosiborod is an internationally-recognised expert in the fields of diabetes and cardiovascular disease, cardiometabolic and cardiorenal syndromes.
Dr Kosiborod is involved in the leadership of numerous clinical trials and multi-center registries, and is currently the principal investigator of several investigator-initiated, multi-center trials in diabetes and cardiovascular disease.
Dr Biykem Bozkurt is the Immediate Past President of the Heart Failure Society of America.
Dr Bozkurt is a Professor of Medicine, an advanced heart failure and cardiac transplantation specialist, Medical Care Line Executive (Medicine Department Chair) at the DeBakey VA Medical Center; W.A. “Tex” and Deborah Moncrief, Jr., Chair; Mary and Gordon Cain Chair; Vice-Chair of Department of Medicine; Director of the Winters Center for Heart Failure and Associate Director of Cardiovascular Research Institute at Baylor College of Medicine.
Consultant Cardiologist and Professor of Cardiology (Hon)
Giuseppe Rosano is Consultant Cardiologist and Professor of Cardiology at St George’s, University of London, UK where he is also the director of MSc Heart Failure.
His research interests focus on experimental and clinical pharmacology, heart failure, cardiac metabolism, diabetes and gender differences in cardiovascular diseases. Prof Rosano has been core member of the Cardiovascular Working Party of the European Medicines Agency and member of the Pricing and Reimbursement Committee of the Italian Drug Agency. He is the President-Elect of the Heart Failure Association Board (HFA), and Chairman of the Education Committee of the HFA. Prof Rosano is on the editorial board for European Journal of Heart Failure, European Heart Journal CV Pharmacotherapy, Cardiac Failure Reviews and Cardiovascular Diabetology. He has authored more than 500 peer…
Director, Heart Failure and Heart Transplant Clinics
Dr Shelley Zieroth is Professor at the College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, as well as Director of the Heart Failure and Heart Transplant Clinics at St Boniface Hospital in Winnipeg, Canada. She is also Head of the Medical Heart Failure Program for Cardiac Sciences Manitoba.
She is involved in several heart failure clinical trials as a PI, National Lead or Executive Committee member. She is the Past President of the Canadian Heart Failure Society and Co-Chair of the Canadian Cardiovascular Society Heart Failure Guidelines. She is co-chair of Canada’s largest annual heart failure meeting, HF Update, and Past President of the Federation of Medical Women of Canada.
Dr Shelley Zieroth is an Editorial Board member of Cardiac Failure Review.