Does evidence-based treatment recommendations implementation improve 1-year outcomes in patients with heart failure?

Introduction Heart failure (HF) is a serious health problem, with a growing incidence and a very high rate of mortality and decompensation. In recent decades there have been progressive changes in its characteristics and treatment. However, these changes and the introduction of new drugs have accelerated in recent years, which may influence more rapid changes in its management and prognosis. Purpose The aim of our study is to assess whether there have been significant changes in the clinical characteristics and management of HF from 2019 to 2024 in Spain. Methods We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology carried out between 2019 and 2024 by 68 specialized HF units. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. The inclusion was performed in 3 phases: 2019-2020, 2021-2022 and 2023-2024, and a comparison of the characteristics, treatment received by the patients and 1-year mortality and HF hospitalizations in those three periods of time was performed. Results Of the 2,245 patients, 27.9% were included in 2019-2020, 43.9% in 2021-2022 and 28.2% in 2023-2024. Figure 1 shows the main clinical characteristics and treatment of the 3 periods. A reduction in the mean age, proportion of women and prevalence of most comorbidities, as well as a lesser HF severity features were observed from the oldest to the most recent period (figure 1). In terms of treatment, there was a significant reduction in the use of diuretics, digoxin, ivabradine and ACEI/ARB, and a very significant increase in ARNI, MRA, SGLT2 inhibitors and potassium chelators (Figure 1). The proportion of patients undergoing cardiac rehabilitation programs also increased (Figure 1). However, 1-year mortality did not decrease, and even the incidence of HF hospitalizations and HF decompensations was significantly higher in the most recent period (figure 2). Conclusions In our contemporary cohort of real-life HF patients, the use of ARNI, SGLT2 inhibitors and MRAs increased very markedly from 2019 to 2024, reflecting a rapid implementation of clinical practice guideline recommendations. However, this was not associated with a reduction in mortality or HF decompensations, despite a lower severity profile of HF in the most recent period. The reasons for this discrepancy should be carefully analyzed.