Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE-HF study
Publication date
2024-07
Authors
Malgie, Jishnu
Wilde, Mariëlle I
Clephas, Pascal R D
Emans, Mireille E
Koudstaal, Stefan
Schaap, Jeroen
Mosterd, Arend
van Ramshorst, Jan
Wardeh, Alexander J
van Wijk, Sandra
Editors
Advisors
Supervisors
Document Type
Article
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cc_by_nc_nd
Abstract
AIMS: Despite clear guideline recommendations for initiating four drug classes in all patients with heart failure (HF) with reduced ejection fraction (HFrEF) and the availability of rapid titration schemes, information on real-world implementation lags behind. Closely following the 2021 ESC HF guidelines and 2023 focused update, the TITRATE-HF study started to prospectively investigate the use, sequencing, and titration of guideline-directed medical therapy (GDMT) in HF patients, including the identification of implementation barriers. METHODS AND RESULTS: TITRATE-HF is an ongoing long-term HF registry conducted in the Netherlands. Overall, 4288 patients from 48 hospitals were included. Among these patients, 1732 presented with de novo, 2240 with chronic, and 316 with worsening HF. The median age was 71 years (interquartile range [IQR] 63-78), 29% were female, and median ejection fraction was 35% (IQR 25-40). In total, 44% of chronic and worsening HFrEF patients were prescribed quadruple therapy. However, only 1% of HFrEF patients achieved target dose for all drug classes. In addition, quadruple therapy was more often prescribed to patients treated in a dedicated HF outpatient clinic as compared to a general cardiology outpatient clinic. In each GDMT drug class, 19% to 36% of non-use in HFrEF patients was related to side-effects, intolerances, or contraindications. In the de novo HF cohort, 49% of patients already used one or more GDMT drug classes for other indications than HF. CONCLUSION: This first analysis of the TITRATE-HF study reports relatively high use of GDMT in a contemporary HF cohort, while still showing room for improvement regarding quadruple therapy. Importantly, the use and dose of GDMT were suboptimal, with the reasons often remaining unclear. This underscores the urgency for further optimization of GDMT and implementation strategies within HF management.
Keywords
Guideline-directed medical therapy, Implementation, Pharmacotherapy, Registry, Sequencing, Titration, Cardiology and Cardiovascular Medicine
Citation
Malgie, J, Wilde, M I, Clephas, P R D, Emans, M E, Koudstaal, S, Schaap, J, Mosterd, A, van Ramshorst, J, Wardeh, A J, van Wijk, S, van den Heuvel, M, Wierda, E, Borleffs, C J W, Saraber, C, Beeres, S L M A, van Kimmenade, R, Jansen Klomp, W, Denham, R, da Fonseca, C A, Klip, IJ T, Manintveld, O C, van der Boon, R M A, van Ofwegen, C E E, Yilmaz, A, Pisters, R, Linssen, G C M, Faber, N, van Heerebeek, L, van de Swaluw, J E C, Bouhuijzen, L J, Post, M C, Kuijper, A F M, Wu, K W, van Beek, E A, Hesselink, T, Kleijn, L, Kurvers, M J M, Tio, R A, Langerveld, J, van Dalen, B M, van Eck, J W M, Handoko, M L, Hermans, W R M, Koornstra-Wortel, H J J, Szymanski, M K, Rooker, D, Tandjung, K, Eijsbouts, S C M, Asselbergs, F W, van der Meer, P, Brunner-La Rocca, H-P, de Boer, R A & Brugts, J J 2024, 'Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients : First data from the TITRATE-HF study', European Journal of Heart Failure, vol. 26, no. 7, pp. 1549-1560. https://doi.org/10.1002/ejhf.3267