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Bergdahl, Ellinor
Publications (4 of 4) Show all publications
Norberg, H., Bergdahl, E. & Lindmark, K. (2019). Safety and Tolerability of Initiating Maximum-Dose Sacubitril-Valsartan in Patients on Target Dose Renin-Angiotensin System Inhibitors. Cardiovascular Therapeutics, 2019, Article ID 6745074.
Open this publication in new window or tab >>Safety and Tolerability of Initiating Maximum-Dose Sacubitril-Valsartan in Patients on Target Dose Renin-Angiotensin System Inhibitors
2019 (English)In: Cardiovascular Therapeutics, ISSN 1755-5914, Vol. 2019, article id 6745074Article in journal (Refereed) Published
Abstract [en]

Aim. Sacubitril-valsartan has proven beneficial in heart failure with reduced ejection fraction. Guidelines recommend initiating half-dose sacubitril-valsartan before up-titration even to patients already on target dose angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB). To reduce the number of titration steps needed in order to simplify for the patient as well as the clinic, we aimed to investigate the safety and tolerability of switching patients on target dose ACE inhibitors or ARBs directly to maximum-dose sacubitril-valsartan. Methods. This prospective cohort study was conducted between April 2016 and November 2017. A total of 66 patients with heart failure and reduced ejection fraction already on guideline-recommended target dose ACE inhibitors or ARBs (equivalent to enalapril 10 mg twice daily) were switched to maximum-dose sacubitril-valsartan (200 mg twice daily). The patients were followed for twelve months. Results. Patients had a mean age of 72 +/- 10 years, mean systolic blood pressure of 121 +/- 17 mmHg, and 92% were male. At 12-month follow-up, nine patients (14%) had discontinued sacubitril-valsartan, four patients (6%) had a dose reduction, and 17 patients (26%) had developed symptomatic hypotension. No angioedema occurred within the 12-month follow-up and there were no hospitalizations or emergency room visits within the first 14 days. Conclusions. Switching directly from target dose ACE inhibitors or ARBs to maximum-dose sacubitril-valsartan was safe and generally well tolerated.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-163076 (URN)10.1155/2019/6745074 (DOI)000481887400001 ()
Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2019-11-14Bibliographically approved
Norberg, H., Bergdahl, E. & Lindmark, K. (2018). Eligibility of sacubitril–valsartan in a real-world heart failure population: a community-based single-centre study. ESC Heart Failure, 5(2), 337-343
Open this publication in new window or tab >>Eligibility of sacubitril–valsartan in a real-world heart failure population: a community-based single-centre study
2018 (English)In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 5, no 2, p. 337-343Article in journal (Refereed) Published
Abstract [en]

Aims: This study aims to investigate the eligibility of the Prospective Comparison of Angiotensin Receptor–Neprilysin Inhibitor (ARNI) with ACE inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM‐HF) study to a real‐world heart failure population.

Methods and results: Medical records of all heart failure patients living within the catchment area of Umeå University Hospital were reviewed. This district consists of around 150 000 people. Out of 2029 patients with a diagnosis of heart failure, 1924 (95%) had at least one echocardiography performed, and 401 patients had an ejection fraction of ≤35% at their latest examination. The major PARADIGM‐HF criteria were applied, and 95 patients fulfilled all enrolment criteria and thus were eligible for sacubitril–valsartan. This corresponds to 5% of the overall heart failure population and 24% of the population with ejection fraction ≤ 35%. The eligible patients were significantly older (73.2 ± 10.3 vs. 63.8 ± 11.5 years), had higher blood pressure (128 ± 17 vs. 122 ± 15 mmHg), had higher heart rate (77 ± 17 vs. 72 ± 12 b.p.m.), and had more atrial fibrillation (51.6% vs. 36.2%) than did the PARADIGM‐HF population.

Conclusions: Only 24% of our real‐world heart failure and reduced ejection fraction population was eligible for sacubitril–valsartan, and the real‐world heart failure and reduced ejection fraction patients were significantly older than the PARADIGM‐HF population. The lack of data on a majority of the patients that we see in clinical practice is a real problem, and we are limited to extrapolation of results on a slightly different population. This is difficult to address, but perhaps registry‐based randomized clinical trials will help to solve this issue.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Heart failure, Sacubitril–Valsartan, Real-world population, PARADIGM-HF, Eligibility, HFrEF
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-151183 (URN)10.1002/ehf2.12251 (DOI)000428992300015 ()29345425 (PubMedID)
Available from: 2018-09-04 Created: 2018-09-04 Last updated: 2019-05-21Bibliographically approved
Jonsson, A., Norberg, H., Bergdahl, E. & Lindmark, K. (2018). Obstacles to mineralocorticoid receptor antagonists in a community-based heart failure population. Cardiovascular therapeutics, 36(5), Article ID e12459.
Open this publication in new window or tab >>Obstacles to mineralocorticoid receptor antagonists in a community-based heart failure population
2018 (English)In: Cardiovascular therapeutics, ISSN 1755-5914, Vol. 36, no 5, article id e12459Article in journal (Refereed) Published
Abstract [en]

AIM: Previous studies and national assessments indicate an undertreatment of mineralocorticoid receptor antagonists (MRA) in heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate why MRA is not used to full extent.

METHODS: A complete community-based heart failure population was studied. Several variables were collected, and medical records were scrutinized to identify reasons for not prescribing MRA.

RESULTS: Of 2029 patients, 812 had EF ≤40%. Five hundred and fifty-three patients (68%) tried MRA at some point but 184 of these (33%) discontinued therapy. There were 259 patients that never tried MRA with 177 with a listed explanation or contraindication. Eighty-two patients, 10% of the total HFrEF population, had no clear contraindications. They were older and had less HF hospitalizations compared to patients on MRA (P < 0.05) and 32% did not have any follow-up at the cardiology clinic. Contraindications to MRA were renal dysfunction (93 patients), hypotension (28 patients), and hyperkalemia (25 patients). Only six patients had hyperkalemia without renal dysfunction. Of the patients with renal dysfunction, 66 (72%) had eGFR >30 mL/min.

CONCLUSIONS: The reasons why MRA are underutilized were mainly because of contraindications. However, the data suggest that physicians are overly cautious about moderately reduced kidney function. There seems to be a 10%-18% avoidable undertreatment with MRA, especially for elderly patients that are admitted to the hospital for other reasons than heart failure. This suggests that patients with heart failure would benefit from routine follow-up at a cardiology clinic.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
heart failure, heart failure with reduced ejection fraction, mineralocorticoid receptor antagonist, undertreatment
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine; Cardiology
Identifiers
urn:nbn:se:umu:diva-151506 (URN)10.1111/1755-5922.12459 (DOI)000444410000008 ()30019390 (PubMedID)
Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2019-05-21Bibliographically approved
Bergdahl, E., Gustavsson, J. M., Kallin, K., von Heideken Wågert, P., Lundman, B., Bucht, G. & Gustafson, Y. (2005). Depression among the oldest old: the Umeå 85+ study. International psychogeriatrics, 17(4), 557-575
Open this publication in new window or tab >>Depression among the oldest old: the Umeå 85+ study
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2005 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 17, no 4, p. 557-575Article in journal (Refereed) Published
Keywords
Activities of Daily Living, Aged, Aged; 80 and over, Body Mass Index, Catchment Area (Health), Cognition Disorders/diagnosis/epidemiology, Cross-Sectional Studies, Depressive Disorder; Major/diagnosis/drug therapy/*epidemiology, Factor Analysis; Statistical, Female, Humans, Logistic Models, Male, Neuropsychological Tests, Polypharmacy, Prevalence, Quality of Life/psychology, Questionnaires, Sweden/epidemiology
Identifiers
urn:nbn:se:umu:diva-6684 (URN)10.1017/S1041610205002267 (DOI)16185377 (PubMedID)
Available from: 2008-01-15 Created: 2008-01-15 Last updated: 2018-06-09Bibliographically approved
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