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Published on: July 12, 2024
Implementation of recommendations regarding pharmacotherapy optimization in patients with heart failure with reduced
Agata Galas1, Robert Morawiec2, Agata Tymińska3
1Department of Cardiology and Internal Diseases, Military Institute of Medicine – National Research Institute, Warszawa, Poland. agalas@wim.mil.pl
Insights
Guideline-directed medical therapy (GDMT) optimization improved heart failure (HF) medication use in hospitalized patients. However, achieving target high-dose GDMT remains suboptimal, indicating a need for improved strategies.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Optimizing guideline-directed medical therapy (GDMT) is crucial for improving heart failure (HF) patient prognosis.
- Chronic care management for HF patients focuses on enhancing GDMT.
- Implementation of GDMT recommendations in HF patients during hospitalization is a key area of study.
Purpose of the Study:
- To assess the implementation of GDMT optimization recommendations in patients hospitalized for heart failure.
- To specifically evaluate GDMT optimization in patients with reduced left ventricular ejection fraction (LVEF).
Main Methods:
- Analysis of 412 patients with known LVEF from the HEROES study (Heart Failure Observational Study of the Polish Cardiac Society).
- Inclusion of patients undergoing scheduled hospitalization across 41 Polish centers.
- Data collected from April 2022 to May 2024.
Main Results:
- In patients with HF with reduced LVEF (HFrEF), medication use (ARNI/ACEI/ARB, beta-blockers, MRA, SGLT2i) increased from admission to discharge.
- Optimization rates for individual GDMT pillars were below 40%.
- Only 22.3% of patients achieved 50% of the target dose for the 4-pillar GDMT.
Conclusions:
- Over 80% of HFrEF patients in the HEROES registry were discharged on 4-pillar GDMT.
- Attainment of target high-dose GDMT in HF patients remains suboptimal.
- Findings highlight national variability in GDMT implementation and the need for dosing optimization strategies.
Introduction:
Optimization of guideline‑directed medical therapy (GDMT) to improve the prognosis of patients with heart failure (HF) is one of the main goals of chronic care.
Objectives:
We aimed to assess implementation of the recommendations regarding GDMT optimization in HF patients undergoing scheduled hospitalization, with particular emphasis on the patients with reduced left ventricular ejection fraction (LVEF).
Patients And Methods:
Our analysis included 412 patients with known LVEF (mean [SD] age, 66.7 [13.5] y; 297 men) admitted for elective hospitalization, representing a subset of 1422 participants of the HEROES study (Heart Failure Observational Study of the Polish Cardiac Society). Recruitment across 41 Polish centers took place from April 2022 to May 2024.
Results:
Mean (SD) LVEF in the study group was 34.9% (14.4%). The patients with HF with reduced LVEF (HFrEF) constituted 69.7% (n = 287) of the whole group. In this subgroup, the use of angiotensin receptor‑neprilysin inhibitor (ARNI) / angiotensin‑converting enzyme inhibitor (ACEI) / angiotensin receptor blocker (ARB) increased from 81.5% of the patients at admission to 88.9% at discharge, of β‑blocker from 85% to 94.4%, of mineralocorticoid receptor antagonist (MRA) from 69.7% to 86.1%, and of sodium‑glucose cotransporter 2 inhibitor (SGLT2i) from 59.2% to 83.6%. ARNI/ACEI/ARB therapy was optimized in 36.2% of the participants, while the rates of optimization were 24.7%, 27.2%, and 24.4% for β‑blockers, MRA, and SGLT2i, respectively. However, only 64 patients (22.3%) attained the 4‑pillar GDMT of SGLT2i, ARNI/ACEI/ARB, β‑blockers, and MRA at doses equal to or above 50% of the target dose.
Conclusions:
In the Polish multicenter HEROES registry, over 80% of the patients with HFrEF were discharged on 4‑pillar GDMT. Nevertheless, the attainment of target high‑dose GDMT remained suboptimal. These findings provide new insights into the variability of GDMT implementation at the national level and underline the need for strategies to improve dosing optimization.
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