Heart failure cardiologists prescribed all four GDMT pillars to 36% of HFrEF patients versus 21% by general cardiologists, with SGLT2i use at 89% vs 49% (p<0.0001).
Does management by a heart failure cardiologist improve the prescribing of guideline-directed medical therapy in patients with HFrEF compared to management by a general cardiologist?
Patients with HFrEF managed by heart failure specialists are significantly more likely to receive comprehensive guideline-directed medical therapy, particularly SGLT2 inhibitors, compared to those managed by general cardiologists.
Absolute Event Rate: 0% vs 0%
Abstract Background The 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure have defined optimal pharmacologic therapies for the treatment of heart failure with a reduced ejection fraction (HFrEF).1 Optimization of guideline-directed medical therapy (GDMT) includes initiation of all four medication classes and titration to targeted or maximally tolerated doses. Data from the CHAMP-HF registry still demonstrates clinical inertia in prescribing GDMT despite clear mortality benefit2. Additionally, EVOLUTION-HF revealed significant discontinuation rates of GDMT at one year3. Purpose This study aims to review and compare prescribing practices of GDMT for patients with HFrEF between a general cardiology practice and a heart failure (HF) cardiology practice. Methods An observational retrospective cohort study was conducted in two outpatient cardiology offices, general cardiology and a cardiology office specializing in advanced heart failure and mechanical circulatory support. The primary outcome was the difference in prescribing of GDMT for patients with HFrEF between general cardiologists and heart failure cardiologists. Secondary outcomes included identifying gaps in prescribing and opportunities for GDMT titration in each clinic site. Patients were randomly selected based on data pulled from outpatient clinic visits at each practice from March to July 2024. Data was analyzed with the chi-squared test. Results A total of 203 patients were included in this study. Most patients were black (61%) males (60%) with an average age of 65 years and NYHA class II or III symptoms. The average baseline ejection fraction (EF) was 32%. There was no difference between prescribing of ARNI, ACEi, ARB or beta-blocker between practices, however, significantly more patients treated by a HF cardiologist were prescribed an SGLT2 inhibitor compared to those treated by general cardiologists (89% v 49%, p-value 0.0001) (Table 2). Significantly more patients treated by a HF cardiologist were on all four pillars of GDMT as compared with those managed by general cardiologists (36% v 21%, p-value of 0.0133) (Table 3). There were significantly more gaps in management by general cardiology providers than seen with HF cardiologists (Table 4). Despite attempts, patients with heart failure may be intolerant to certain GDMT based on blood pressure, renal function or other factors. Conclusions The expansion of GDMT has increased the complexity of appropriate HF therapy. Maintaining patients with HFrEF on all four pillars of GDMT remains a challenge. However, patients managed by HF cardiologists were more likely to be on appropriate therapy and had less opportunities for medication titration than those managed by a general cardiologist. Opportunity remains for increased utilization of ARNI for further reduction in mortality in both practices.
Straw et al. (Sat,) reported a other. Heart failure cardiologists prescribed all four GDMT pillars to 36% of HFrEF patients versus 21% by general cardiologists, with SGLT2i use at 89% vs 49% (p<0.0001).
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