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Updated: Jan 12, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Optimisation of heart failure management: insights into GDMT and loop diuretic utilisation in a specialised heart
Evelyne Meekers1,2, Zara Arcidiacono2, Romy Baptist2
1Department of Cardiology, Ziekenhuis Oost-Limburg A.V., Genk, Belgium.
Insights
Heart failure clinics are optimizing care by reducing loop diuretic use and increasing guideline-directed medical therapy (GDMT). This shift aims to improve patient outcomes and reduce diuretic dependence.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Loop diuretics are commonly used in heart failure (HF) but linked to poorer outcomes.
- High prescription rates of loop diuretics persist despite evidence.
- Guideline-directed medical therapy (GDMT) may mitigate the need for loop diuretics.
Purpose of the Study:
- To evaluate loop diuretic and GDMT prescription patterns in a Belgian HF clinic.
- To compare these patterns with findings from recent HF trials.
Main Methods:
- Prospective registry of 1000 consecutive HF patients (LVEF ≤50%) from an outpatient HF clinic.
- Data collected via electronic health records, including demographics, medications, and echocardiography.
Main Results:
- 54.3% of patients had HF with reduced ejection fraction; median age 72, median LVEF 45%.
- GDMT prescription was high (68.7% on triple/quadruple therapy).
- Loop diuretic use was significantly lower (27%) compared to recent trials.
Conclusions:
- HF clinics are making progress in optimizing patient care.
- A patient-centered approach in HF clinics can reduce loop diuretic dependence.
- Further optimization of care and comorbidity management is essential.
Background And Aims:
Loop diuretic maintenance therapy has been associated with worse clinical outcomes in heart failure (HF) patients. Despite this, recent HF trials report high prescription rates. Optimal guideline-directed medical therapy (GDMT) may reduce need for loop diuretics and improve long-term outcomes. This study evaluated loop diuretic and GDMT prescription patterns in a HF clinic of a Belgian tertiary hospital cohort and compared findings to recent HF trials.
Methods:
This prospective registry included consecutive HF patients with a left ventricular ejection fraction (LVEF) ≤50% from the HF outpatient clinic starting from 23 November 2023 to 22 May 2024 up to the inclusion of 1000 patients. Data on baseline characteristics, medications, echocardiography and laboratory were extracted from electronical health records.
Results:
Among the included patients, 543 (54.3%) had HF with reduced ejection fraction. Median age was 72 (63-80) years, with a median LVEF of 45% (35-45). Most were male (72.6%), with serum creatinine of 1.15 (0.93-1.45) mg/dL and eGFR of 60 (43-77) mL/min/1.73 m2. Hypertension (56%), atrial fibrillation (47%), and coronary revascularisation (53%) were common comorbidities. GDMT prescription rates were high, with 68.7% on triple or quadruple therapy, while only 27% received loop diuretics. Baseline characteristics and GDMT prescription rates were comparable to recent registries and trials, but loop diuretic prescriptions were significantly lower in the current cohort.
Conclusions:
This study highlights progress in HF management but emphasises the need for a patient-centred approach in a HF clinic which enables optimisation of care, allows addressing comorbidities, and reduction in loop diuretic dependence.
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