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. 2024 Feb;26(2):327-337.
doi: 10.1002/ejhf.3081. Epub 2023 Nov 22.

Guideline-directed medical therapy in severe heart failure with reduced ejection fraction: An analysis from the HELP-HF registry

Daniela Tomasoni #  1   2 , Matteo Pagnesi #  1 , Giada Colombo  1 , Mauro Chiarito  3   4 , Davide Stolfo  5 , Luca Baldetti  6 , Carlo Mario Lombardi  1 , Marianna Adamo  1 , Giuseppe Maggi  1 , Riccardo Maria Inciardi  1 , Ferdinando Loiacono  3 , Marta Maccallini  3   4 , Alessandro Villaschi  3   4 , Gaia Gasparini  3   4 , Marco Montella  3   4 , Stefano Contessi  5 , Daniele Cocianni  5 , Maria Perotto  5 , Giuseppe Barone  6 , Marco Merlo  5 , Alberto Maria Cappelletti  6 , Giuseppe Rosano  7 , Gianfranco Sinagra  5 , Daniela Pini  3 , Gianluigi Savarese  2 , Marco Metra  1
Affiliations
Free article

Guideline-directed medical therapy in severe heart failure with reduced ejection fraction: An analysis from the HELP-HF registry

Daniela Tomasoni et al. Eur J Heart Fail. 2024 Feb.
Free article

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.

Keywords: Advanced heart failure; Evidence‐based medical therapy; Guideline‐directed medical therapy; Heart failure with reduced ejection fraction; Prescription; Prognosis; Severe heart failure.

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References

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