Key result
Quadruple GDMT remains underused in HFrEF, with only ~47% of patients receiving all four classes.
Why the study?
Despite guideline recommendations, guideline-directed medical therapy remains underused and underdosed in patients with heart failure across the ejection fraction spectrum.
Observational (n=3,054)
Yes
The OPTIPHARM-HF registry highlights that while the adoption of quadruple therapy in HFrEF and SGLT2i in HFmrEF/HFpEF has increased, guideline-directed medical therapy remains underused and underdosed across the ejection fraction spectrum in contemporary practice.
GDMT underuse persists in contemporary Italian HF registry; leaves open effective implementation strategies for prospective trials.
AIMS: Despite guideline recommendations, guideline-directed medical therapy (GDMT) remains underused and underdosed in patients with heart failure (HF) across the ejection fraction (EF) spectrum. The aim of this study was to evaluate GDMT use, dosing, and implementation in a contemporary, nationwide HF cohort. METHODS AND RESULTS: The OPTIPHARM-HF (NCT06192524) is a prospective, multicentre, observational study enrolling adult patients with HF, across 32 Italian HF centres. Clinical characteristics, medical therapy prevalence and change after first visit have been assessed in patients with reduced (HFrEF: EF ≤40%), mildly reduced (HFmrEF: EF 40-49%), and preserved EF (HFpEF: EF ≥50%). From September 2022 to December 2024, 3054 patients (mean age 69 ± 12 years, 25% female) were enrolled: 56% with HFrEF, 21% with HFmrEF, and 23% with HFpEF. Among HFrEF, prescription frequencies were: 90% for beta-blockers; 19% for angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARB); 61% for angiotensin receptor-neprilysin inhibitors (ARNI); 72% for mineralocorticoid receptor antagonists (MRA); and 69% for sodium-glucose co-transporter 2 inhibitors (SGLT2i). Less than 60% achieved ≥50% of target doses. Quadruple therapy was received by 47% of the patients. After first visit, there was an increase in prescription of all classes of drugs, and titration to quadruple therapy was attained in 64% (p < 0.001). Among HFmrEF, 88% were on beta-blockers, 34% on ACEi/ARB, 49% on ARNI, 63% on MRA, and 59% on SGLT2i. In the HFpEF group, 76% were on beta-blockers, 49% on ACEi/ARB, 18% on ARNI, 49% on MRA and 40% on SGLT2i. After the first visit, SGLT2i prescription significantly increased both in HFmrEF (74%, p < 0.001) and HFpEF (54%, p < 0.001). CONCLUSIONS: Use of GDMT remains suboptimal across the EF spectrum although the adoption of quadruple GDMT in HFrEF and of SGLT2i in HFmrEF and HFpEF increased in recent years.
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Inciardi et al. (2025) conducted an observational in Heart failure (n=3,054). Guideline-directed medical therapy (GDMT) was evaluated on Prescription frequencies and dosing of guideline-directed medical therapy across the ejection fraction spectrum. Guideline-directed medical therapy remains underused and underdosed across the heart failure spectrum, with only 47% of HFrEF patients receiving quadruple therapy and less than 60% achieving at least half of target doses.
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