Savarese, G;
Lindberg, F;
Christodorescu, RM;
Ferrini, M;
Kumler, T;
Toutoutzas, K;
Dattilo, G;
Bayes-Genis, A;
Moura, B;
Amir, O;
et al.
Savarese, G; Lindberg, F; Christodorescu, RM; Ferrini, M; Kumler, T; Toutoutzas, K; Dattilo, G; Bayes-Genis, A; Moura, B; Amir, O; Petrie, MC; Seferovic, P; Chioncel, O; Metra, M; Coats, AJS; Rosano, GMC
(2024)
Physician perceptions, attitudes, and strategies towards implementing guideline-directed medical therapy in heart failure with reduced ejection fraction. A survey of the Heart Failure Association of the ESC and the ESC Council for Cardiology Practice.
Eur J Heart Fail, 26 (6).
pp. 1408-1418.
ISSN 1879-0844
https://doi.org/10.1002/ejhf.3214
SGUL Authors: Rosano, Giuseppe Massimo Claudio
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Abstract
AIMS: Recent guidelines recommend four core drug classes (renin-angiotensin system/angiotensin receptor-neprilysin inhibitor [RASi/ARNi], beta-blocker, mineralocorticoid receptor antagonist [MRA], and sodium-glucose cotransporter 2 inhibitor [SGLT2i]) for the pharmacological management of heart failure (HF) with reduced ejection fraction (HFrEF). We assessed physicians' perceived (i) comfort with implementing the recent HFrEF guideline recommendations; (ii) status of guideline-directed medical therapy (GDMT) implementation; (iii) use of different GDMT sequencing strategies; and (iv) barriers and strategies for achieving implementation. METHODS AND RESULTS: A 26-question survey was disseminated via bulletin, e-mail and social channels directed to physicians with an interest in HF. Of 432 respondents representing 91 countries, 36% were female, 52% were aged <50 years, and 90% mainly practiced in cardiology (30% HF). Overall comfort with implementing quadruple therapy was high (87%). Only 12% estimated that >90% of patients with HFrEF without contraindications received quadruple therapy. The time required to initiate quadruple therapy was estimated at 1-2 weeks by 34% of respondents, 1 month by 36%, 3 months by 24%, and ≥6 months by 6%. The average respondent favoured traditional drug sequencing strategies (RASi/ARNi with/followed by beta-blocker, and then MRA with/followed by SGLT2i) over simultaneous initiation or SGLT2i-first sequences. The most frequently perceived clinical barriers to implementation were hypotension (70%), creatinine increase (47%), hyperkalaemia (45%) and patient adherence (42%). CONCLUSIONS: Although comfort with implementing all four core drug classes in patients with HFrEF was high among physicians, a majority estimated implementation of GDMT in HFrEF to be low. We identified several important perceived clinical and non-clinical barriers that can be targeted to improve implementation.
Item Type: | Article | ||||||||
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Additional Information: | © 2024 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 License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. | ||||||||
Keywords: | Guideline‐directed medical therapy, Heart failure with reduced ejection fraction, Treatment implementation, Heart failure with reduced ejection fraction, Guideline-directed medical therapy, Treatment implementation, 1102 Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology | ||||||||
SGUL Research Institute / Research Centre: | ?? 61 ?? | ||||||||
Journal or Publication Title: | Eur J Heart Fail | ||||||||
ISSN: | 1879-0844 | ||||||||
Language: | eng | ||||||||
Dates: |
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Publisher License: | Creative Commons: Attribution-Noncommercial 4.0 | ||||||||
PubMed ID: | 38515385 | ||||||||
Web of Science ID: | WOS:001188826900001 | ||||||||
Go to PubMed abstract | |||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/116587 | ||||||||
Publisher's version: | https://doi.org/10.1002/ejhf.3214 |
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