117 Medicines optimisation before discharge in patients admitted to hospital with heart failure

Background In the UK, approximately half of patients with heart failure and a reduced ejection fraction (HeFREF) are discharged from hospital on triple therapy (angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA). It is unknown what proportion of patients would be eligible for uptitration of medicines prior to discharge, nor how many might be eligible for initiation of sacubitril-valsartan or sodium-glucose co-transporter-2 inhibitors (SGLT2I).Methods Between 2012 and 2017, 1,277 patients admitted with suspected heart failure were enrolled at a single hospital serving a local community around Kingston-Upon-Hull, UK. Eligibility for sacubitril-valsartan or SGLT2I was based on entry criteria for the PIONEER-HF, DAPA-HF and EMPEROR-Reduced trials.Results 455 patients had HeFREF with complete data on renal function, heart rate and systolic blood pressure (SBP) on discharge. 83% were taking an ACEI/ARB, 85% a BB and 63% MRA on discharge (figure 1). More than 60% were eligible for sacubitril-valsartan and more than 70% for SGLT2i (figure 2). Among those not already receiving a each drug, 37%, 28%, and 49% were eligible to start ACEI/ARB, BB, or MRA respectively (tables 1 and 2). Low SBP (&lt;105 mmHg) was the most common reason for failure to initiate or up-titrate (table 2).Conclusion Most patients admitted for heart failure are eligible for initiation of life prolonging medications prior to discharge. A hospital admission may be a common missed opportunity to improve treatment for HeFREF<br/

Prognostic value of the chest x-ray in patients hospitalised for heart failure

Background: Patients admitted to hospital with heart failure will have had a chest X-ray (CXR), but little is known about their prognostic significance. We aimed to report the prevalence and prognostic value of the initial chest radiograph findings in patients admitted to hospital with heart failure (acute heart failure, AHF). Methods: The erect CXRs of all patients admitted with AHF between October 2012 and November 2016 were reviewed for pulmonary venous congestion, Kerley B lines, pleural effusions and alveolar oedema. Film projection (whether anterior–posterior [AP] or posterior–anterior [PA]) and cardiothoracic ratio (CTR) were also recorded. Trial registration: ISRCTN96643197 Results: Of 1145 patients enrolled, 975 [median (interquartile range) age 77 (68–83) years, 61% with moderate, or worse, left ventricular systolic dysfunction, and median NT-proBNP 5047 (2337–10,945) ng/l] had an adequate initial radiograph, of which 691 (71%) were AP. The median CTR was 0.57 (IQR 0.53–0.61) in PA films and 0.60 (0.55–0.64) in AP films. Pulmonary venous congestion was present in 756 (78%) of films, Kerley B lines in 688 (71%), pleural effusions in 649 (67%) and alveolar oedema in 622 (64%). A CXR score was constructed using the above features. Increasing score was associated with increasing age, urea, NT-proBNP, and decreasing systolic blood pressure, haemoglobin and albumin; and with all-cause mortality on multivariable analysis (hazard ratio 1.10, 95% confidence intervals 1.07–1.13, p &lt; 0.001). Conclusions: Radiographic evidence of congestion on a CXR is very common in patients with AHF and is associated with other clinical measures of worse prognosis