Guideline-directed medical therapy in severe heart failure with reduced ejection fraction : An analysis from the HELP-HF registry
© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology..
AIM: Persistent symptoms despite guideline-directed medical therapy (GDMT) and poor tolerance of GDMT are hallmarks of patients with advanced heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data on GDMT use, dose, and prognostic implications are lacking.
METHODS AND RESULTS: We included 699 consecutive patients with HFrEF and at least one 'I NEED HELP' marker for advanced HF enrolled in a multicentre registry. Beta-blockers (BB) were administered to 574 (82%) patients, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNI) were administered to 381 (55%) patients and 416 (60%) received mineralocorticoid receptor antagonists (MRA). Overall, ≥50% of target doses were reached in 41%, 22%, and 56% of the patients on BB, ACEi/ARB/ARNI and MRA, respectively. Hypotension, bradycardia, kidney dysfunction and hyperkalaemia were the main causes of underprescription and/or underdosing, but up to a half of the patients did not receive target doses for unknown causes (51%, 41%, and 55% for BB, ACEi/ARB/ARNI and MRA, respectively). The proportions of patients receiving BB and ACEi/ARB/ARNI were lower among those fulfilling the 2018 HFA-ESC criteria for advanced HF. Treatment with BB and ACEi/ARB/ARNI were associated with a lower risk of death or HF hospitalizations (adjusted hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.48-0.84, and HR 0.74, 95% CI 0.58-0.95, respectively).
CONCLUSIONS: In a large, real-world, contemporary cohort of patients with severe HFrEF, with at least one marker for advanced HF, prescription and uptitration of GDMT remained limited. A significant proportion of patients were undertreated due to unknown reasons suggesting a potential role of clinical inertia either by the prescribing healthcare professional or by the patient. Treatment with BB and ACEi/ARB/ARNI was associated with lower mortality/morbidity.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
European journal of heart failure - 26(2024), 2 vom: 02. Feb., Seite 327-337 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tomasoni, Daniela [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 27.03.2024 Date Revised 27.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/ejhf.3081 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Tomasoni, Daniela |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Guideline-directed medical therapy in severe heart failure with reduced ejection fraction |b An analysis from the HELP-HF registry |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 27.03.2024 | ||
| 500 | |a Date Revised 27.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. | ||
| 520 | |a AIM: Persistent symptoms despite guideline-directed medical therapy (GDMT) and poor tolerance of GDMT are hallmarks of patients with advanced heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data on GDMT use, dose, and prognostic implications are lacking | ||
| 520 | |a METHODS AND RESULTS: We included 699 consecutive patients with HFrEF and at least one 'I NEED HELP' marker for advanced HF enrolled in a multicentre registry. Beta-blockers (BB) were administered to 574 (82%) patients, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNI) were administered to 381 (55%) patients and 416 (60%) received mineralocorticoid receptor antagonists (MRA). Overall, ≥50% of target doses were reached in 41%, 22%, and 56% of the patients on BB, ACEi/ARB/ARNI and MRA, respectively. Hypotension, bradycardia, kidney dysfunction and hyperkalaemia were the main causes of underprescription and/or underdosing, but up to a half of the patients did not receive target doses for unknown causes (51%, 41%, and 55% for BB, ACEi/ARB/ARNI and MRA, respectively). The proportions of patients receiving BB and ACEi/ARB/ARNI were lower among those fulfilling the 2018 HFA-ESC criteria for advanced HF. Treatment with BB and ACEi/ARB/ARNI were associated with a lower risk of death or HF hospitalizations (adjusted hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.48-0.84, and HR 0.74, 95% CI 0.58-0.95, respectively) | ||
| 520 | |a CONCLUSIONS: In a large, real-world, contemporary cohort of patients with severe HFrEF, with at least one marker for advanced HF, prescription and uptitration of GDMT remained limited. A significant proportion of patients were undertreated due to unknown reasons suggesting a potential role of clinical inertia either by the prescribing healthcare professional or by the patient. Treatment with BB and ACEi/ARB/ARNI was associated with lower mortality/morbidity | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Advanced heart failure | |
| 650 | 4 | |a Evidence‐based medical therapy | |
| 650 | 4 | |a Guideline‐directed medical therapy | |
| 650 | 4 | |a Heart failure with reduced ejection fraction | |
| 650 | 4 | |a Prescription | |
| 650 | 4 | |a Prognosis | |
| 650 | 4 | |a Severe heart failure | |
| 650 | 7 | |a Angiotensin-Converting Enzyme Inhibitors |2 NLM | |
| 650 | 7 | |a Angiotensin Receptor Antagonists |2 NLM | |
| 650 | 7 | |a Adrenergic beta-Antagonists |2 NLM | |
| 650 | 7 | |a Mineralocorticoid Receptor Antagonists |2 NLM | |
| 700 | 1 | |a Pagnesi, Matteo |e verfasserin |4 aut | |
| 700 | 1 | |a Colombo, Giada |e verfasserin |4 aut | |
| 700 | 1 | |a Chiarito, Mauro |e verfasserin |4 aut | |
| 700 | 1 | |a Stolfo, Davide |e verfasserin |4 aut | |
| 700 | 1 | |a Baldetti, Luca |e verfasserin |4 aut | |
| 700 | 1 | |a Lombardi, Carlo Mario |e verfasserin |4 aut | |
| 700 | 1 | |a Adamo, Marianna |e verfasserin |4 aut | |
| 700 | 1 | |a Maggi, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Inciardi, Riccardo Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Loiacono, Ferdinando |e verfasserin |4 aut | |
| 700 | 1 | |a Maccallini, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Villaschi, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Gasparini, Gaia |e verfasserin |4 aut | |
| 700 | 1 | |a Montella, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Contessi, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Cocianni, Daniele |e verfasserin |4 aut | |
| 700 | 1 | |a Perotto, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Barone, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Merlo, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Cappelletti, Alberto Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Rosano, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Sinagra, Gianfranco |e verfasserin |4 aut | |
| 700 | 1 | |a Pini, Daniela |e verfasserin |4 aut | |
| 700 | 1 | |a Savarese, Gianluigi |e verfasserin |4 aut | |
| 700 | 1 | |a Metra, Marco |e verfasserin |4 aut | |
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