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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Implementation of guideline-directed medical therapy in patients with heart failure with reduced ejection fraction
Stefania Paolillo1, Christian Basile1, Federica Marzano1
1Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Insights
The OPTIMA-HF registry shows heart failure with reduced ejection fraction (HFrEF) patients receive guideline-directed medical therapy, but less than half achieve optimal combination treatment or target doses. Strategies are needed to improve HFrEF management and patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- European guidelines recommend four fundamental drugs for chronic heart failure with reduced ejection fraction (HFrEF).
- The Optimization of Therapy in the Italian Management of Heart Failure (OPTIMA-HF) registry collects real-world data on HF patient care.
- This analysis focuses on the initial findings regarding guideline-directed medical therapy (GDMT) in HFrEF patients.
Purpose of the Study:
- To assess the real-world utilization of GDMT in Italian outpatients with HFrEF.
- To evaluate prescription rates, dosages, and combination therapy of fundamental HFrEF drugs.
- To identify gaps in GDMT implementation and adherence to European guidelines.
Main Methods:
- An observational, cross-sectional, multicentre study (OPTIMA-HF registry) in Italian hospital and community settings.
- Retrospective data collection (T0 phase) from January to October 2022.
- Analysis of HFrEF drug prescription rates, types, doses, contraindications, and reasons for non-optimized treatment.
Main Results:
- 1390 HFrEF patients were analyzed from 29 centers.
- High prescription rates for renin-angiotensin-aldosterone system inhibitor/angiotensin receptor neprilysin inhibitor (RAASi/ARNI) (89.1%), beta-blockers (95.1%), mineralocorticoid receptor antagonists (MRA) (75.8%), and sodium/glucose cotransporter 2 inhibitors (SGLT2i) (63.2%).
- Only 46.9% of patients received all four drug classes, and suboptimal doses were common for RAASi/ARNI and beta-blockers.
Conclusions:
- Most HFrEF patients in Italy receive fundamental HF medications.
- Less than 50% of patients achieve optimal combination therapy with the four key drug classes.
- Improved strategies are necessary to enhance GDMT implementation and target dosages for better HFrEF prognosis.
Aims:
The last released European guidelines on the management of heart failure (HF) recommend in patients with chronic HF with reduced ejection fraction (HFrEF) a pharmacological approach based on four fundamental drugs to be rapidly implemented and then uptitrated to modify disease progression. The aim of the Optimization of Therapy in the Italian Management of Heart Failure (OPTIMA-HF) registry is to collect data on chronic HF outpatients in different settings of care. In the present analysis, we report the first analysis of the OPTIMA-HF registry, focusing on the real-life use of guideline-directed medical therapy in patients affected by HFrEF.
Methods:
OPTIMA-HF is an observational, cross-sectional, multicentre, real-life Italian registry conducted in two different clinical settings: HF outpatients' clinics of Italian hospitals and community HF outpatients' services. The study comprises a T0 phase-retrospective data collection, in which data of consecutive HF outpatients seen between January and October 2022 were collected; an educational activity phase; and a T1 phase-prospective data collection, in which data of consecutive HF outpatients seen between September 2023 and November 2023 were collected. In the present analysis, we describe the T0 phase focusing on HFrEF drug prescription rates, types, doses, combination therapy, the presence of contraindications and reasons of non-optimized treatment.
Results:
Twenty-nine centres enrolled 2110 HF patients, of which 1390 (65.9%) had HFrEF [69.5 ± 11.9 years, 76.2% males, 4.1 years since HF diagnosis, median ejection fraction (EF) 33%]. Among HFrEF patients, 89.1% were on treatment with renin-angiotensin-aldosterone system inhibitor (RAASi)/angiotensin receptor neprilysin inhibitor (ARNI) (72% ARNI and 17.1% RAASi), 95.1% with beta-blockers, 75.8% with mineralocorticoid receptor antagonists (MRA) and 63.2% with sodium/glucose cotransporter 2 inhibitors (SGLT2i). Despite high prescription rates, a non-negligible number of patients with no contraindications were not treated with each specific drug. Patients taking all four drug classes, as recommended by guidelines, were mere 46.9%. Regarding doses, a still low number of patients on RAASi/ARNI and beta-blockers were treated with a dose ≥50% of the target doses recommended by the European guidelines.
Conclusions:
The OPTIMA-HF registry reported that HFrEF fundamental drugs are prescribed in most Italian patients; however, <50% of patients receive optimal combination therapy, and still not a satisfying number of patients receive target doses. Strategies to improve implementation of guideline-directed medical therapy are needed to improve HF prognosis.
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