Key result
Highest-risk HFrEF profiles account for only ~5% of patients in real-world clinical practice.
Why the study?
Following Heart Failure Association recommendations to optimize guideline-directed medical treatments according to patient profiles, this analysis investigated the prevalence, characteristics, treatments, and outcomes of these individual profiles.
What is the prevalence and corresponding prognostic risk of specific clinical profiles based on vital signs, renal function, and comorbidities in real-world patients with HFrEF?
Cohort (n=47,241)
Yes
What is the prevalence and corresponding prognostic risk of specific clinical profiles based on vital signs, renal function, and comorbidities in real-world patients with HFrEF?
Applying the HFA patient profiling tool to a real-world registry demonstrates that standard obstacles to GDMT implementation (like severe hypotension, hyperkalemia, or advanced CKD) are relatively uncommon, suggesting much of the gap in therapy optimization is due to clinical inertia rather than true contraindications.
Aims The Heart Failure Association of the European Society of Cardiology has recently proposed to optimize guideline-directed medical treatments according to patient's profiles. The aim of this analysis was to investigate prevalence/characteristics/treatments/outcomes for individual profiles. Methods and results Patients with heart failure (HF) with reduced ejection fraction (HFrEF) enrolled in the Swedish Heart Failure Registry (SwedeHF) between 2013 and 2021 were considered. Among 108 profiles generated by combining different strata of renal function (by estimated glomerular filtration rate [eGFR]), systolic blood pressure (sBP), heart rate, atrial fibrillation (AF) status and presence of hyperkalaemia, 93 were identified in our cohort. Event rates for a composite of cardiovascular (CV) mortality or first HF hospitalization were calculated for each profile. The nine most frequent profiles accounting for 70.5% of the population had eGFR 30–60 or ≥60 ml/min/1.73 m2, sBP 90–140 mmHg and no hyperkalaemia. Heart rate and AF were evenly distributed. The highest risk of CV mortality/first HF hospitalization was observed in those with concomitant eGFR 30–60 ml/min/1.73 m2 and AF. We also identified nine profiles with the highest event rates, representing only 5% of the study population, characterized by no hyperkalaemia, even distribution among the sBP strata, predominance of eGFR <30 ml/min/1.73 m2 and AF. The three profiles with eGFR 30–60 ml/min/1.73 m2 also showed sBP <90 mmHg. Conclusions In a real-world cohort, most patients fit in a few easily identifiable profiles; the nine profiles at highest risk of mortality/morbidity accounted for only 5% of the population. Our data might contribute to identifying profile-tailored approaches to guide drug implementation and follow-up.
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Musella et al. (2023) conducted a cohort in Heart Failure with Reduced Ejection Fraction (HFrEF) (n=47,241). Clinical patient profiles (based on combinations of eGFR, sBP, HR, AF status, and hyperkalemia) was evaluated on Composite of cardiovascular mortality or first HF hospitalization. In a real-world HFrEF cohort, most patients fit into a few easily identifiable profiles, while the nine profiles at highest risk of mortality/morbidity accounted for only 5% of the population.
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