Medical Therapy in Patients with Heart Failure: A Delphi Consensus from Italian Cardiologists

Area of Science:

• Cardiology
• Pharmacology
• Clinical Practice

Background:

• Adherence to clinical guidelines is essential for optimal heart failure (HF) management.
• Cardiologists' approaches to HF clinical scenarios were explored in relation to current guidelines.
• A Delphi analysis via electronic questionnaires assessed expert opinions during HF meetings.

Purpose of the Study:

• To investigate cardiologists' practical application of heart failure management guidelines.
• To identify consensus and variations in therapeutic preferences among HF specialists.
• To understand approaches to medication use, including diuretics, SGLT2 inhibitors, and MRAs.

Main Methods:

• Electronic questionnaires distributed to cardiologists during HF-focused meetings.
• Data collected from 108 participants (57 men, 51 women).
• Analysis of responses regarding treatment scenarios and drug class preferences.

Main Results:

• Strong consensus on beta-blocker benefits for HF prognosis and mortality reduction.
• Preference for intravenous loop diuretics combined with thiazides; metolazone less favored.
• SGLT2 inhibitors (SGLT2i) reduce hospitalizations; consensus lacking on replacing MRAs.
• MRAs discontinued for hyperkalemia/renal dysfunction, prioritizing renal safety.
• Near-unanimous agreement on early sacubitril/valsartan initiation post-hospitalization stabilization.

Conclusions:

• 97% of cardiologists prefer using all guideline-recommended HF drug classes, adapting doses as needed.
• Comprehensive therapy targeting multiple HF mechanisms is prioritized.
• Personalized treatment strategies are crucial, balancing guidelines with individual patient factors.