Implementation of recommendations regarding pharmacotherapy optimization in patients with heart failure with reduced ejection fraction undergoing scheduled hospitalization: the HEROES study.

INTRODUCTION

Optimization of guideline‑directed medical therapy (GDMT) to improve the prognosis of patients with heart failure (HF) is one of the main goals of chronic care.

OBJECTIVES

We aimed to assess implementation of the recommendations regarding GDMT optimization in HF patients undergoing scheduled hospitalization, with particular emphasis on the patients with reduced left ventricular ejection fraction (LVEF).

PATIENTS AND

METHODS

Our analysis included 412 patients with known LVEF (mean [SD] age, 66.7 [13.5] y; 297 men) admitted for elective hospitalization, representing a subset of 1422 participants of the HEROES study (Heart Failure Observational Study of the Polish Cardiac Society). Recruitment across 41 Polish centers took place from April 2022 to May 2024.

RESULTS

Mean (SD) LVEF in the study group was 34.9% (14.4%). The patients with HF with reduced LVEF (HFrEF) constituted 69.7% (n = 287) of the whole group. In this subgroup, the use of angiotensin receptor‑neprilysin inhibitor (ARNI) / angiotensin‑converting enzyme inhibitor (ACEI) / angiotensin receptor blocker (ARB) increased from 81.5% of the patients at admission to 88.9% at discharge, of β‑blocker from 85% to 94.4%, of mineralocorticoid receptor antagonist (MRA) from 69.7% to 86.1%, and of sodium‑glucose cotransporter 2 inhibitor (SGLT2i) from 59.2% to 83.6%. ARNI/ACEI/ARB therapy was optimized in 36.2% of the participants, while the rates of optimization were 24.7%, 27.2%, and 24.4% for β‑blockers, MRA, and SGLT2i, respectively. However, only 64 patients (22.3%) attained the 4‑pillar GDMT of SGLT2i, ARNI/ACEI/ARB, β‑blockers, and MRA at doses equal to or above 50% of the target dose.

CONCLUSIONS

In the Polish multicenter HEROES registry, over 80% of the patients with HFrEF were discharged on 4‑pillar GDMT. Nevertheless, the attainment of target high‑dose GDMT remained suboptimal. These findings provide new insights into the variability of GDMT implementation at the national level and underline the need for strategies to improve dosing optimization.