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Multicenter Study
. 2024 Jul;26(7):1549-1560.
doi: 10.1002/ejhf.3267. Epub 2024 May 12.

Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE-HF study

Jishnu Malgie #  1 , Mariëlle I Wilde #  1 , Pascal R D Clephas  1 , Mireille E Emans  2 , Stefan Koudstaal  3 , Jeroen Schaap  4   5 , Arend Mosterd  6 , Jan van Ramshorst  7 , Alexander J Wardeh  8 , Sandra van Wijk  9 , Mieke van den Heuvel  10 , Eric Wierda  11 , C Jan Willem Borleffs  12 , Colette Saraber  13 , Saskia L M A Beeres  14 , Roland van Kimmenade  15 , Wouter Jansen Klomp  16 , Robert Denham  17 , Carlos A da Fonseca  18 , IJsbrand T Klip  4   19 , Olivier C Manintveld  1 , Robert M A van der Boon  1 , Clara E E van Ofwegen  20 , Ayten Yilmaz  21 , Ron Pisters  22 , Gerard C M Linssen  23 , Nikola Faber  24 , Loek van Heerebeek  25 , Julio E C van de Swaluw  26 , Lex J Bouhuijzen  27 , Marco C Post  28   29 , Aaf F M Kuijper  30 , Ka Wai Wu  31 , Eugène A van Beek  32 , Tim Hesselink  33 , Lennaert Kleijn  34 , Maurice J M Kurvers  35 , René A Tio  36 , Jorina Langerveld  37 , Bas M van Dalen  38 , J W Martijn van Eck  39 , M Louis Handoko  40 , Walter R M Hermans  41 , Hetty J J Koornstra-Wortel  42 , Mariusz K Szymanski  29 , Dennis Rooker  43 , Kenneth Tandjung  44 , Sabine C M Eijsbouts  45 , Folkert W Asselbergs  40 , Peter van der Meer  46 , Hans-Peter Brunner-La Rocca  47   48 , Rudolf A de Boer  1 , Jasper J Brugts  1
Affiliations
Free article
Multicenter Study

Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE-HF study

Jishnu Malgie et al. Eur J Heart Fail. 2024 Jul.
Free article

Abstract

Aims: Despite clear guideline recommendations for initiating four drug classes in all patients with heart failure (HF) with reduced ejection fraction (HFrEF) and the availability of rapid titration schemes, information on real-world implementation lags behind. Closely following the 2021 ESC HF guidelines and 2023 focused update, the TITRATE-HF study started to prospectively investigate the use, sequencing, and titration of guideline-directed medical therapy (GDMT) in HF patients, including the identification of implementation barriers.

Methods and results: TITRATE-HF is an ongoing long-term HF registry conducted in the Netherlands. Overall, 4288 patients from 48 hospitals were included. Among these patients, 1732 presented with de novo, 2240 with chronic, and 316 with worsening HF. The median age was 71 years (interquartile range [IQR] 63-78), 29% were female, and median ejection fraction was 35% (IQR 25-40). In total, 44% of chronic and worsening HFrEF patients were prescribed quadruple therapy. However, only 1% of HFrEF patients achieved target dose for all drug classes. In addition, quadruple therapy was more often prescribed to patients treated in a dedicated HF outpatient clinic as compared to a general cardiology outpatient clinic. In each GDMT drug class, 19% to 36% of non-use in HFrEF patients was related to side-effects, intolerances, or contraindications. In the de novo HF cohort, 49% of patients already used one or more GDMT drug classes for other indications than HF.

Conclusion: This first analysis of the TITRATE-HF study reports relatively high use of GDMT in a contemporary HF cohort, while still showing room for improvement regarding quadruple therapy. Importantly, the use and dose of GDMT were suboptimal, with the reasons often remaining unclear. This underscores the urgency for further optimization of GDMT and implementation strategies within HF management.

Keywords: Guideline‐directed medical therapy; Implementation; Pharmacotherapy; Registry; Sequencing; Titration.

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References

    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022;24:4–131. https://doi.org/10.1002/ejhf.2333
    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al.; ESC Scientific Document Group. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2024;26:5–17. https://doi.org/10.1002/ejhf.3024
    1. Mebazaa A, Davison B, Chioncel O, Cohen‐Solal A, Diaz R, Filippatos G, et al. Safety, tolerability and efficacy of up‐titration of guideline‐directed medical therapies for acute heart failure (STRONG‐HF): A multinational, open‐label, randomised, trial. Lancet 2022;400:1938–1952. https://doi.org/10.1016/S0140‐6736(22)02076‐1
    1. Brunner‐La Rocca HP, Linssen GC, Smeele FJ, van Drimmelen AA, Schaafsma HJ, Westendorp PH, et al.; CHECK‐HF Investigators. Contemporary drug treatment of chronic heart failure with reduced ejection fraction: The CHECK‐HF registry. JACC Heart Fail 2019;7:13–21. https://doi.org/10.1016/j.jchf.2018.10.010
    1. Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, et al. Medical therapy for heart failure with reduced ejection fraction: The CHAMP‐HF registry. J Am Coll Cardiol 2018;72:351–366. https://doi.org/10.1016/j.jacc.2018.04.070

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