[The changes in the pharmacotherapy of heart failure with reduced ejection fraction and its effect on prognosis: experience in the Hungarian clinical practice]

Abstract

Introduction: According to the 2021 ESC Heart Failure (HF) Guidelines (GLs), the conventional triple therapy (TT) (RASi + βB + MRA) has been supplemented with the SGLT2i dapa-/empagliflozin as the fourth pillar of the quadruple therapy (QT) recommended for all patients with heart failure with reduced ejection fraction HFrEF. Objective: To assess the implementation and impact on the prognosis of the HFrEF QT (TT + SGLT2i) in the light of the 2021 HF GLs. Method: A retrospective data analysis of a consecutive cohort of HFrEF patients hospitalized for HF from 04/01/2021 to 12/31/2023 at our Institute was performed. The patients were classified into two groups: those hospitalized before and those after the publication of the 2021 ESC HF GLs. Differences in the implementation of the drug therapy were analyzed by the Fisher test. 1-year mortality was compared using Kaplan–Meier analysis and log-rank test. Results: A cohort of 346 patients (male: 76%, age: 61 [50–70] years, coronary artery disease: 46%, diabetes: 36%, atrial fibrillation/flutter: 42%, LVEF: 25 [20–30]%, estimated glomerular filtration rate: 57 [45–73] ml/min/1.73 m2; NT-proBNP: 4848 [2389–9307] pg/ml) was treated with a high proportion of TT (83%) and QT (51%) at discharge. After the publication of the 2021 ESC HF GLs, the proportion of patients on SGLT2i-s improved (19% vs. 60%, p<0.001; before vs. after the publication of the GLs), resulting in an increased proportion of patients on QT (19% vs. 54%, p<0.001). There was no significant difference between the groups regarding the use of TT (0% vs. 3%) or QT (0% vs. 2%) at target doses. 1-year mortality was more favourable in those receiving QT (12% vs. 13% vs. 32%, p<0.001; QT vs. TT vs. non-TT/non-QT). Conclusions: In the light of the 2021 ESC HF GLs, the introduction of SGLT2-s and the use of QT were feasible even in the everyday practice among HFrEF patients requiring hospitalization and were accompanied by better prognosis compared to those without TT/QT. Orv Hetil. 2024; 165(18): 698–710.

Keywords: csökkent ejekciós frakciójú szívelégtelenség; gyógyszeres terápia; heart failure with reduced ejection fraction; nátrium-glükóz-kotranszporter-2-gátló; négyes terápia; pharmacotherapy; prognosis; prognózis; quadruple therapy; sodium-glucose co-transporter 2 inhibitor.