TY - JOUR
T1 - Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients
T2 - First data from the TITRATE-HF study
AU - Malgie, Jishnu
AU - Wilde, Mariëlle I
AU - Clephas, Pascal R D
AU - Emans, Mireille E
AU - Koudstaal, Stefan
AU - Schaap, Jeroen
AU - Mosterd, Arend
AU - van Ramshorst, Jan
AU - Wardeh, Alexander J
AU - van Wijk, Sandra
AU - van den Heuvel, Mieke
AU - Wierda, Eric
AU - Borleffs, C Jan Willem
AU - Saraber, Colette
AU - Beeres, Saskia L M A
AU - van Kimmenade, Roland
AU - Jansen Klomp, Wouter
AU - Denham, Robert
AU - da Fonseca, Carlos A
AU - Klip, IJsbrand T
AU - Manintveld, Olivier C
AU - van der Boon, Robert M A
AU - van Ofwegen, Clara E E
AU - Yilmaz, Ayten
AU - Pisters, Ron
AU - Linssen, Gerard C M
AU - Faber, Nikola
AU - van Heerebeek, Loek
AU - van de Swaluw, Julio E C
AU - Bouhuijzen, Lex J
AU - Post, Marco C
AU - Kuijper, Aaf F M
AU - Wu, Ka Wai
AU - van Beek, Eugène A
AU - Hesselink, Tim
AU - Kleijn, Lennaert
AU - Kurvers, Maurice J M
AU - Tio, René A
AU - Langerveld, Jorina
AU - van Dalen, Bas M
AU - van Eck, J W Martijn
AU - Handoko, M Louis
AU - Hermans, Walter R M
AU - Koornstra-Wortel, Hetty J J
AU - Szymanski, Mariusz K
AU - Rooker, Dennis
AU - Tandjung, Kenneth
AU - Eijsbouts, Sabine C M
AU - Asselbergs, Folkert W
AU - van der Meer, Peter
AU - Et al.
AU - Brunner La Rocca, Hans-Peter
AU - Brugts, Jasper J.
PY - 2024/7
Y1 - 2024/7
N2 - 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.
AB - 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.
KW - Guideline-directed medical therapy
KW - Implementation
KW - Pharmacotherapy
KW - Registry
KW - Sequencing
KW - Titration
U2 - 10.1002/ejhf.3267
DO - 10.1002/ejhf.3267
M3 - Article
SN - 1388-9842
VL - 26
SP - 1549
EP - 1560
JO - European journal of heart failure
JF - European journal of heart failure
IS - 7
ER -