Avaliação da conduta terapêutica para pacientes com insuficiência cardíaca com fração de ejeção reduzida do Centro de Especialidades Médicas do CESUPA

Abstract

Heart failure (HF) is a worldwide problem associated with high mortality and low quality of life. It is not a single pathological diagnosis, but a clinical syndrome characterized by clinical signs that are a result of impaired ventricular filling, the ability of the ventricles to eject blood, or both. HF can be classified into 3 distinct phenotypes, according to left ventricular ejection fraction (LVEF), into HF with preserved ejection fraction (HFpEF), mildly reduced ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF). With regard to HFpEF, drugs that can modify the natural history of the disease in patients with this phenotype have not yet been identified, in contrast to the treatment of HFrEF, which has a wide range of drug therapies capable of reducing morbidity and mortality when using targeted optimized doses by guidelines. To analyze whether the therapeutic approach for patients with HF with reduced ejection fraction (HFrEF) at CEMEC (Cesupa Medical Specialty Center) is in accordance with the guidelines recommended by the main Brazilian and global guidelines on HF. This is an observational, retrospective and quantitative study, through the analysis of medical records of patients with HFrEF between the years 2018 and 2021, registered at CEMEC, identifying whether the therapeutic approach is in accordance with the guidelines brazilian and worldwide on HF. 54 patients were included in the study, attended by the Center for Medical Specialties of CESUPA between 2018 and 2021. Among the patients analyzed, more than half (53.7%) were male and most (74, 1%) was elderly, aged between 60 and 98 years. During the study, it was decided to analyze medical records of patients with HFmrEF for a complementary analysis. In this study, most patients (61.1%) had a reduced ejection fraction and 38.9% had a slightly reduced ejection fraction. In the individual analysis of drug classes, 21 individuals were using ACE inhibitors, most of them were using Enalapril, and 12 (57%) were on optimized doses. With regard to ARBs, 26 patients were using, mostly Losartan, and 15 (59%) had optimized doses. The BB class, whose most used representative is Carvedilol, had a total of only 1 patient out of 52 (1.9%) at full dose. As for the MRA class, represented in Brazil by Spironolactone, it was found that 38 patients used it and 35 (92%) were at the minimum recommended dose. Furthermore, only 1 patient was using Sacubitril-Valsartan (ARNI) and 6 were using SGLT2 Inhibitors, and all were on full dose. Therefore, all CEMEC patients with HFrEF and HFmrEF use at least one of the drugs that modify the prognosis of the disease, in addition to the majority being within the recommended target dose. Drugs that interfere with the renin-angiotensin-aldosterone system showed a high prevalence of patients on full-dose medication. Regarding MRA, almost all patients already use the target dose of the drug. Regarding BB, it is observed that, in general, patients need to be better informed about the need to use these medications, in order to reach the target dose.