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Medical Treatments in Patients With Ambulatory Heart Failure: First Data From the BRING-UP-3 Heart Failure Study
Fabrizio Oliva1, Francesco Orso2, Furio Colivicchi3
1Cardiology Unit. Niguarda Hospital, Milano, Italy.
Insights
Italian heart failure patients show high adherence to guideline-recommended treatments, including the 4 pillars for HFrEF and SGLT2 inhibitors for HFmrEF and HFpEF.
Area of Science:
- Cardiology
- Pharmacotherapy
- Clinical Research
Background:
- European Society of Cardiology guidelines recommend a 4-pillar treatment approach for Heart Failure with reduced Ejection Fraction (HFrEF).
- Class IA recommendations exist for SGLT2 inhibitors (empagliflozin, dapagliflozin) in Heart Failure with mildly reduced Ejection Fraction (HFmrEF) and preserved Ejection Fraction (HFpEF).
Purpose of the Study:
- To guide guideline-implementation recommendations for Heart Failure (HF) patients in Italy.
- To assess the prescription rates of guideline-recommended therapies within a large cohort of Italian cardiology sites.
Main Methods:
- Observational, prospective, nationwide investigation (BRING-UP-3 HF study) across 179 Italian sites.
- Inclusion of ambulatory and hospitalized HF patients with an educational intervention, enrollment periods, and a 6-month follow-up.
- Focus on baseline data from the ambulatory cohort to evaluate the proportion of HFrEF patients receiving the 4 pillars.
Main Results:
- 3830 ambulatory patients included; mean age 70 ± 12 years, 21.9% female.
- HFrEF was the most prevalent group (58.4%), followed by HFimpEF, HFmrEF, and HFpEF.
- High prescription rates observed: 65% for the 4 pillars in HFrEF (beta-blockers & RASis >90%, SGLT2is & MRAs >80%).
- SGLT2 inhibitor prescription rates were 72.1% in HFmrEF and 50.1% in HFpEF.
Conclusions:
- A large-scale analysis in Italian cardiology sites demonstrates substantial adherence to guideline-recommended treatments for HF.
- The study highlights high prescription rates for foundational therapies in HFrEF and the increasing use of SGLT2 inhibitors in other HF phenotypes.
Background:
Current European Society of Cardiology guidelines introduced a 4-pillar approach for the treatment of HFrEF and a class IA recommendations for empagliflozin and dapagliflozin in HFmrEF and HFpEF.
Objectives:
The BRING-UP-3 Heart Failure (HF) study was designed to guide the Guideline-implementation recommendations for patients with HF enrolled in a large sample of Italian cardiology sites.
Methods:
The BRING-UP-3 HF study is an observational, prospective, nationwide investigation encompassing 179 sites and enrolling ambulatory and hospitalized patients with HF. The study includes an educational intervention followed by 2 3-month enrolment periods and by a 6-month follow-up period with end-point evaluation. For patients with HFrEF, the objective is to describe the proportion of patients who receive the 4 pillars. Here we present the baseline data of the ambulatory cohort.
Results:
A total of 3830 ambulatory patients were included in the study. The mean age was 70 ± 12 years (34.5% older than 75 years), females were 21.9%. The most prevalent group was HFrEF (58.4%), followed by HFimpEF (17.4%), HFmrEF (14.4%), and HFpEF (9.8%). Hypertension, atrial fibrillation, diabetes mellitus, and chronic kidney disease were reported in 68.2%, 40.4%, 31.0%, and 33.1%, respectively. In patients with HFrEF, a high prescription rate (65%) for the 4 therapeutic pillars was observed; beta-blockers and RASis (mostly ARNIs) were prescribed in over 90%, while SGLT2is and MRAs were prescribed in over 80% of cases. In HFmrEF and HFpEF, SGLT2i prescription rates reached 72.1% and 50.1%, respectively.
Conclusions:
A comprehensive analysis of a large sample of Italian cardiology sites revealed a high prevalence of prescription of guideline-recommended treatments.
Clinicaltrial:
GOV: NCT06279988.
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