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. 2025 Sep 24.
doi: 10.1002/ejhf.70031. Online ahead of print.

Contemporary implementation of guideline-directed medical and device therapies in heart failure: Insights from the Central/Eastern Europe Quality of Care Centres Survey

Petar M Seferović  1   2 , Marija Polovina  1   3 , Jan Krejči  4 , Bela Merkely  5 , Mariya Tokmakova  6 , Martin Huelssmann  7 , Vladimir Miloradović  8   9 , Svetlana Apostolović  10   11 , Elizabeta Srbinovska-Kostovska  12 , Slavica Radovanović  13 , Anastazija Stojšić-Milosavljević  14   15 , Aleksandra Milovančev  14   15 , Marija Zdravković  1   16 , Duška Glavaš  17 , Tamara Preradović-Kovačević  18   19 , Eva Goncalvesova  20 , Michal Laufer-Perl  21 , Nataša Marković-Nikolić  1   22 , Zumreta Kušljugić  23   24 , Larisa Hudić-Dizdarević  23   24 , Dan Gaita  25 , Ginta Kamzola  26 , Robert Sepp  27 , Dragan Simić  1   3 , Arsen Ristić  1   3 , Milika Ašanin  1   3 , Gordana Krljanac  1   3 , Petar Otašević  1   28 , Dejana Stanisavljević  1   29 , Davor Miličić  30   31 , Magdy Abdelhamid  32 , Gianluigi Savarese  33   34 ; Central/Eastern Europe QCC Survey Young Investigators
Collaborators, Affiliations

Contemporary implementation of guideline-directed medical and device therapies in heart failure: Insights from the Central/Eastern Europe Quality of Care Centres Survey

Petar M Seferović et al. Eur J Heart Fail. .

Abstract

Aims: The Central/Eastern Europe (CEE) Quality of Care Centres (QCC) Survey evaluated the implementation of guideline-directed medical therapies (GDMT) and device use at discharge after heart failure (HF) hospitalization in CEE, where GDMT underutilization remains a concern.

Methods and results: Between March 2024 and January 2025, 2251 patients (mean age 70.0 years, 60.4% male) were enrolled at discharge from 21 centres across 12 CEE countries. The patient population included HF with reduced ejection fraction (HFrEF) (55.5%), HF with mildly reduced ejection fraction (15.3%) and HF with preserved ejection fraction (27.9%). In the total population, from admission to discharge there was a increase in the use of angiotensin receptor-neprilysin inhibitor (ARNI) (17.1% to 34.3%), beta-blockers (69.4% to 92.4%), mineralocorticoid receptor antagonists (MRA) (44.0% to 82.1%) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) (30.8% to 79.9%), with a reduction in angiotensin-converting enzyme inhibitor (ACEI) use (all p < 0.05). Similar trends were observed across HF phenotypes, including HFrEF (increased use of ARNI, 26.3% to 55.1%, beta-blockers, 69.8% to 95.3%, MRA 49.5% to 89.0%, and SGLT2I 36.2% to 79.8%, and lower ACEI use, all p < 0.05). At discharge, 53.5% of patients received quadruple therapy (63.9% with HFrEF), while ≥50% target doses of titratable drugs were achieved in 18.8% (17.8% in HFrEF). Predictors of GDMT underuse included older age, lower education, living alone, non-ischaemic HF, higher ejection fraction, chronic kidney disease, hypotension, hyperkalaemia, prolonged hospitalization, and residual oedema. Among eligible HFrEF patients, 21.3% were discharged with, or referred for implantable cardioverter-defibrillator, and 17.4% for cardiac resynchronization therapy.

Conclusions: The CEE-QCC Survey highlights substantial in-hospital GDMT implementation and up-titration, though device use remains limited. Targeted strategies are needed to enhance guideline implementation and ensure optimal HF care across the CEE region.

Keywords: Guideline‐directed medical therapy; Heart failure; Heart failure device; Implementation; Quality of care; Survey.

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References

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