Related Experiment Video
Updated: Jun 13, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Implementation of guideline-directed medical therapy for heart failure patients with reduced ejection fraction in
Joke Devoldere1, Steven Droogmans2, Ward A Heggermont3
1Medical Affairs, BioPharmaceuticals, AstraZeneca, Groot-Bijgaarden, Belgium.
Insights
Belgian experts reached consensus on implementing guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). Key recommendations include rapid initiation of four cornerstone therapies and individualized treatment sequencing for optimal patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Practice Guidelines
Background:
- The 2021 European Society of Cardiology (ESC) guidelines advocate for a four-pillar medical therapy strategy for heart failure with reduced ejection fraction (HFrEF), emphasizing near-simultaneous initiation.
- Practical implementation guidance for this strategy is currently lacking in clinical practice.
- A Delphi Panel of 12 Belgian heart failure experts convened to establish consensus on integrating guideline-directed medical therapy (GDMT) into Belgian clinical practice for HFrEF patients, considering local factors like reimbursement.
Purpose of the Study:
- To achieve expert consensus on the practical implementation of GDMT for HFrEF in Belgium.
- To address the gap in practical guidance for initiating the four-pillar therapy strategy.
- To consider local specificities, including reimbursement criteria, in the consensus-building process.
Main Methods:
- A three-round Delphi process involving 12 geographically representative Belgian cardiologists.
- Initial open-ended questions evolved into 39 statements following qualitative analysis.
- Statements were categorized for newly diagnosed and chronic HFrEF patients.
Main Results:
- Consensus was reached on initiating the four cornerstone medical therapies within 7-14 days of HFrEF diagnosis, prioritizing initiation over up-titration.
- No consensus was found on a fixed sequence for initiating therapies due to patient variability and national reimbursement criteria.
- Experts emphasized tailoring treatment adjustments to individual patient presentation and comorbidities, and the importance of regular follow-up for therapy optimization.
Conclusions:
- This national Delphi consensus provides practical guidance for Belgian cardiologists on implementing GDMT in HFrEF.
- The consensus stresses the need for rapid initiation of the four cornerstone therapies in newly diagnosed HFrEF patients.
- Individualized treatment sequencing and regular follow-up are crucial for optimizing medical therapy in HFrEF management.
Background:
The 2021 European Society of Cardiology (ESC) guidelines recommended a shift from a traditional hierarchical treatment for heart failure with reduced ejection fraction (HFrEF) to a four-pillar medical therapy strategy intended for near-simultaneous initiation. However, practical guidance for implementation in clinical practice is lacking. To address this, a Delphi Panel of 12 Belgian heart failure experts aimed to obtain consensus on integrating guideline-directed medical therapy (GDMT) in HFrEF patients in Belgian clinical practice, considering local specificities, including reimbursement criteria.
Methods:
A geographically representative sample of 12 Belgian cardiologists engaged in a three-round Delphi process, evolving from 20 open-ended questions to 39 statements. A qualitative analysis after the first round resulted in expert statements for the subsequent questionnaire, categorised into treatment for newly diagnosed and chronic HFrEF patients.
Results:
The Delphi consensus revealed four key findings: (i) Agreement on initiating the four medical cornerstones within 7-14 days of HFrEF diagnosis, prioritising initiation over individual class up-titration; (ii) Lack of consensus on a fixed sequence for initiation due to patient variability and national reimbursement criteria; (iii) Emphasis on treatment adjustment based on the patient's clinical presentation and comorbidities; (iv) Recognition of the crucial role of regular follow-up visits, allowing optimisation of medical therapy where appropriate.
Conclusion:
This national Delphi consensus addresses clinical implementation of GDMT in HFrEF patients for Belgian cardiologists. The consensus highlights the importance of swift implementation of the four cornerstone medical therapies in newly diagnosed HFrEF patients, individualising treatment sequencing, and ensuring regular follow-up to optimise therapy.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:22Heart Failure Drugs: β-Blockers
01:17Pathophysiology of Heart Failure
01:22Heart Failure Drugs: Diuretics