In patients with de novo HFrEF, quadruple therapy was achieved in 58.1% at discharge and 63.7% at follow-up, but only 3.5% of those on quadruple therapy achieved maximum doses across all classes.
Observational (n=370)
Yes
Real-world data reveals a significant gap in achieving target doses of guideline-directed medical therapy for HFrEF, highlighting the critical need to initiate comprehensive therapy during the initial hospitalization.
Abstract Background Clinical trials like STRONG emphasize the importance of optimizing heart failure (HF) therapy by titrating medications to maximum doses. However, real-world data suggests that achieving maximum doses across all HF drug classes is rare. Additionally, the initiation of comprehensive HF therapy during hospitalization appears to be a critical determinant for long-term therapeutic adherence. This study evaluates the discharge treatment patterns and subsequent uptitration in patients with de novo HF and reduced ejection fraction (HFrEF) from our registry. Methods We analyzed patients from a prospective registry of de novo HFrEF (LVEF ≤ 40%) admitted to two tertiary hospitals between March 2021 and October 2023. We assessed the distribution of treatments by drug classes and the number of drug classes prescribed at discharge, as well as changes after a mean follow-up period of 97 days. Uptitration success was measured by the percentage of patients achieving maximum doses in each drug class. Results Among 370 patients at discharge, 91.3% were prescribed beta-blockers, 61.9% ARNI, 77.6% MRAs, and 81.6% SGLT2i. Quadruple therapy was achieved in 58.1%, with limited changes after uptitration (63.7% at follow-up). Despite efforts, only 16.0% of patients on beta-blockers, 27.0% on RASi, 54.0% on MRAs, and 100% on SGLT2i reached maximum doses. Notably, 3.5% of patients receiving quadruple therapy achieved maximum doses across all drug classes. Uptitration primarily benefited those already initiated on foundational HF therapies during hospitalization, as the addition of new drug classes post-discharge was rare. Conclusion Our real-world data highlight a significant gap between guideline-recommended HF management strategies and clinical practice. Initiating optimal HF therapy during hospitalization is critical, as post-discharge uptitration or the addition of missing drug classes is infrequent. These findings emphasize the importance of comprehensive HF management during the initial hospitalization to maximize long-term therapeutic outcomes.
Garcia et al. (2025) conducted an observational in De novo heart failure with reduced ejection fraction (HFrEF) (n=370). Heart failure therapy (beta-blockers, ARNI/RASi, MRAs, SGLT2i) was evaluated on Distribution of treatments by drug classes, number of drug classes prescribed at discharge, and uptitration success (percentage achieving maximum doses). In patients with de novo HFrEF, quadruple therapy was achieved in 58.1% at discharge and 63.7% at follow-up, but only 3.5% of those on quadruple therapy achieved maximum doses across all classes.