An analysis of heart failure reduced ejection fraction pharmacotherapy sequencing strategies
department or school: Pharmaceutical Sciences, Faculty of
data provider: DSpace
degree campus: UBCV
creator: Van, Minh Tri
issued: 2025-09-30T07:00:00Z
issued: 2023
related degree: Master of Science - MSc
degree grantor: University of British Columbia
description: Introduction: Heart failure with reduced ejection fraction (HFrEF) is a debilitating condition that can be managed with pharmacotherapy, consisting of an angiotensin receptor- neprilysin inhibitor (ARNI), a beta-blocker (BB), a mineralocorticoid receptor antagonist (MRA), and a sodium-glucose cotransporter-2 inhibitor (SGLT2I). However, the optimal process of initiating and titrating these medications, known as sequencing strategy, is widely debated. Methods and Results: A scoping review was conducted to identify ambulatory sequencing strategies for treatment-naïve, de novo HFrEF patients, revealing a trend in the selection of attributes from the identified strategies, with a focus on expediting the initiation of quadruple therapy. Two attributes were found to heavily influence this trend: the number of medications initiated during the first visit and whether to prioritize initiation or titration. Based on these attributes, we developed a framework to classify sequencing strategies into 3 strategy types, and proposed 2 profiles to represent each type. A benefit-harm and cost-utility analysis was performed using an individual-based state-transition microsimulation model, where each profile was modeled in 2 versions with medication adjustment made fortnightly (a) or weekly (b). Probabilistic analysis of 10,000 trials and 1,000 samples with a willingness-to-pay threshold of $50,000/QALY were conducted, along with one-way sensitivity analysis, and 2 scenario analyses. The analysis demonstrated that the incremental cost-effectiveness among the different strategies is minimal, favoring more intensive strategies after considering benefits, harms and costs. In the base scenario, âsimultaneousâ sequencing strategy with fortnightly adjustment (Profile 6a) was most likely to be cost-effective. However, in the scenario where sub-target doses were assumed to be ineffective, strategies involved weekly adjustment were more likely to be optimal compared to fortnightly adjustment. …
aggregated CHO: https://circle.library.ubc.ca/rest/handle/2429/85637
note: AN ANALYSIS OF HEART FAILURE REDUCED EJECTION FRACTION PHARMACOTHERAPY SEQUENCING STRATEGIES by Minh Tri Van Pharm.D., The University of Cincinnati, 2019 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Pharmaceutical Sciences) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) August 2023 © Minh Tri Van, 2023 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, the thesis entitled: An analysis of heart failure reduced ejection fraction pharmacotherapy sequencing strategies submitted by Minh Tri Van in partial fulfilment of the requirements for the degree of Master of Science in Pharmaceutical Sciences Examining Committee: Ricky Turgeon, Assistant Professor, Faculty of Pharmaceutical Sciences, UBC Supervisor Peter Shane Loewen, Associate Professor, Faculty of Pharmaceutical Sciences, UBC Co-supervisor Mohsen Sadatsafavi, Associate Professor, Faculty of Pharmaceutical Sciences, UBC Supervisory Committee Member Kate Johnson, Assistant Professor, Faculty of Pharmaceutical Sciences, UBC Additional Examiner Additional Supervisory Committee Members: Nathaniel Hawkins, Clinical Assistant Professor, Cardiology Division, UBC Supervisory Committee Member Wei Zhang, Associate Professor, Faculty of Pharmaceutical Sciences, UBC Supervisory Committee Member iii Abstract Introduction: Heart failure with reduced ejection fraction (HFrEF) is a debilitating condition that can be managed with pharmacotherapy, consisting of an angiotensin receptor- neprilysin inhibitor (ARNI), a beta-blocker (BB), a mineralocorticoid receptor antagonist (MRA), and a sodium-glucose cotransporter-2 inhibitor (SGLT2I). However, the optimal process of initiating and titrating these medications, known as sequencing strategy, is widely debated. Methods and Results: A scoping review was conducted to identify ambulatory sequenc…
has type: Thesis/Dissertation
date issued: 2023-11
is shown at: 10.14288/1.0435587
language: eng
degree discipline: Pharmaceutical Sciences
provider: Vancouver : University of British Columbia Library
publisher: University of British Columbia
rights: Attribution-NonCommercial-NoDerivatives 4.0 International
rights URI: http://creativecommons.org/licenses/by-nc-nd/4.0/
scholar level: Graduate
contributor: Turgeon, Ricky
contributor: Loewen, Peter
type: Text
identifier URI: http://hdl.handle.net/2429/85637