Tomasoni, D;
Pagnesi, M;
Colombo, G;
Chiarito, M;
Stolfo, D;
Baldetti, L;
Lombardi, CM;
Adamo, M;
Maggi, G;
Inciardi, RM;
et al.
Tomasoni, D; Pagnesi, M; Colombo, G; Chiarito, M; Stolfo, D; Baldetti, L; Lombardi, CM; Adamo, M; Maggi, G; Inciardi, RM; Loiacono, F; Maccallini, M; Villaschi, A; Gasparini, G; Montella, M; Contessi, S; Cocianni, D; Perotto, M; Barone, G; Merlo, M; Cappelletti, AM; Rosano, G; Sinagra, G; Pini, D; Savarese, G; Metra, M
(2024)
Guideline-directed medical therapy in severe heart failure with reduced ejection fraction: an analysis from the HELP-HF registry.
Eur J Heart Fail, 26 (2).
pp. 327-337.
ISSN 1879-0844
https://doi.org/10.1002/ejhf.3081
SGUL Authors: Rosano, Giuseppe Massimo Claudio
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Abstract
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.
Item Type: | Article | ||||||||
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Additional Information: | © 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. | ||||||||
Keywords: | Advanced heart failure, Evidence-based medical therapy, Guideline-directed medical therapy, Heart failure with reduced ejection fraction, Prescription, Prognosis, Severe heart failure, 1102 Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) | ||||||||
Journal or Publication Title: | Eur J Heart Fail | ||||||||
ISSN: | 1879-0844 | ||||||||
Language: | eng | ||||||||
Dates: |
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Publisher License: | Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0 | ||||||||
PubMed ID: | 37933210 | ||||||||
Go to PubMed abstract | |||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/116115 | ||||||||
Publisher's version: | https://doi.org/10.1002/ejhf.3081 |
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