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Management of Heart Failure with Reduced Ejection Fraction after ESC 2016 Heart Failure Guidelines: The Linx Registry

Fernando de Frutos1, Sonia Mirabet2, Luis Ortega-Paz3

  • 1Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain.

ESC Heart Failure
|January 10, 2020
PubMed

Insights

Heart failure (HF) management in reduced ejection fraction patients shows good adherence to European Society of Cardiology (ESC) guidelines. While sacubitril/valsartan use is increasing, achieving target drug doses remains a challenge.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Practice

Background:

  • The European Society of Cardiology (ESC) released updated guidelines for heart failure (HF) management in May 2016.
  • Effective management of HF with reduced ejection fraction (HFrEF) is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the real-world management of HFrEF patients following the publication of the 2016 ESC HF Guidelines.
  • To assess adherence to guideline-recommended pharmacological treatments in a contemporary HFrEF cohort.

Main Methods:

  • The study utilized data from the Linx registry, a multicentre, observational, cross-sectional study.
  • 1056 patients with HFrEF (left ventricular ejection fraction ≤40%) were enrolled from 14 Catalan hospitals between February and April 2017.
  • Prescription patterns and achievement of target doses for guideline-recommended HF medications were analyzed.

Main Results:

  • Sacubitril/valsartan was prescribed to 23.9% of patients, leading to decreased use of ACE inhibitors and ARBs as monotherapy.
  • High rates of beta-blocker (91.8%) and mineralocorticoid receptor antagonist (72.7%) prescription were observed.
  • Low proportions of patients achieved target doses for most guideline-directed medical therapies, including beta-blockers (25.4%) and sacubitril/valsartan (8.1%).
  • Higher prescription and up-titration rates of guideline-recommended drugs were noted in more complex hospitals.

Conclusions:

  • The Linx registry demonstrates good adherence to the pharmacological recommendations of the ESC HF Guidelines for HFrEF.
  • Despite overall adherence, a significant challenge remains in achieving target doses for guideline-directed medical therapies.
  • The uptake of sacubitril/valsartan was substantial within months of its recommendation in the guidelines.
Abstract

Keywords:
Chronic heart failureGuidelinesHeart failureManagementSacubitril/valsartan

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