Is It Time for Polypill in Heart Failure Therapy? Current Preference among Indian Cardiologists: A Cross-sectional Survey

Export Background and Aim: Quadruple therapy plays a key role in heart failure (HF) management and the latest recommendation is “four pillar drugs on board in 4 weeks.” At present, there is no fixed-dose combination (FDC) of these foundational therapies existing in India. The present study aimed to understand Indian cardiologists’ perspectives on FDC of quadruple therapy in HF management. Methods: A cross-sectional, questionnaire-based study was conducted between December 2022 and April 2023 among cardiologists from India. The survey questionnaire consisted of six closed-ended questions covering clinical practices and preference for FDC of foundational therapy in HF management. Results: A total of 80 cardiologists participated in the study. The majority of the cardiologists (66.25%) strongly agreed with the need for FDC of HF pillar drugs, whereas 31.25% held a neutral opinion. Sodium-glucose cotransporter 2 inhibitors based FDC were most preferred (46.25%) followed by angiotensin receptor-neprilysin inhibitor (ARNI) (38.75%) and beta-blocker (33.8%) based FDC. With regard to the dose strengths of combinations, most cardiologists (61.25%) opined that there was a need for both high and low doses of FDC, whereas one-third (32.50%) felt low-dose strength of FDC to be sufficient. Regarding the place in therapy, 52.50% of cardiologists suggested the introduction of FDC after stabilization with free pills, whereas 43.75% suggested initiation of therapy with FDC. A large majority of cardiologists (83.75%) strongly agreed that the use of FDC will simplify the dosage regimen and improve medication adherence with HF patients. Conclusion: Overall observations suggest the preference of Indian cardiologists toward the need for FDC of quadruple therapy in HF management.