International journal of cardiology. Heart & vasculature · 2026
Implementation of guideline-directed medical therapy among patients with acute heart failure admitted to cardiac rehabilitation: the PROMETEO registry.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Villaschi Alessandro, Oreni Maria Letizia, Toccafondi Anastasia, Cusmano Ignazio, Gonella Stefano, Gonella Riccardo, Coni Gaia, Torri Anna, Grati Paola, Ambrosetti Marco, Cianflone Domenico, Morici Nuccia
Аннотация
BACKGROUND AND AIMS: To provide a contemporary description of patients referred to cardiac rehabilitation (CR) in Italy after hospitalization for acute heart failure (HF), focusing on the use and optimization of guideline-directed medical therapy (GDMT) across the spectrum of left-ventricular ejection fraction (LVEF).
METHODS: PROMETEO is a prospective, multicentre Italian registry enrolling consecutive adult patients admitted to CR after acute HF. Patients were stratified as HFrEF (LVEF <40%) or HFmrEF/HFpEF (LVEF ≥40%).
RESULTS: Among 263 patients with available LVEF, median age was 68.7 years, 21.7% were female, and 74.9% had HFrEF. Compared with HFmrEF/HFpEF, HFrEF were younger, less frequently female and with higher NT-proBNP levels. At CR admission, 72.1% of HFrEF patients received ACEi/ARB/ARNI, 91.9% beta-blockers, 79.2% MRAs, and 66.0% SGLT2 inhibitors, with a median GDMT score of 6 (IQR 4-8). At discharge, ARNI use increased significantly (58.9%) and the median GDMT score increased to 7 (IQR 4-8; p = 0.013), alongside higher beta-blocker dosing and reduced loop diuretic use. Chronic kidney disease and higher baseline GDMT score were negatively associated with GDMT optimization, while higher BMI showed a positive association. In HFmrEF/HFpEF patients, SGLT2 inhibitor use increased from 28.8% to 47.0% (p = 0.010), with a concomitant reduction in loop diuretic prescription and dose.
CONCLUSION: Patients referred to CR after acute HF are mainly male with HFrEF and show substantial comorbidity and treatment complexity. Residential CR represents a key opportunity for GDMT optimization across the HF spectrum.
METHODS: PROMETEO is a prospective, multicentre Italian registry enrolling consecutive adult patients admitted to CR after acute HF. Patients were stratified as HFrEF (LVEF <40%) or HFmrEF/HFpEF (LVEF ≥40%).
RESULTS: Among 263 patients with available LVEF, median age was 68.7 years, 21.7% were female, and 74.9% had HFrEF. Compared with HFmrEF/HFpEF, HFrEF were younger, less frequently female and with higher NT-proBNP levels. At CR admission, 72.1% of HFrEF patients received ACEi/ARB/ARNI, 91.9% beta-blockers, 79.2% MRAs, and 66.0% SGLT2 inhibitors, with a median GDMT score of 6 (IQR 4-8). At discharge, ARNI use increased significantly (58.9%) and the median GDMT score increased to 7 (IQR 4-8; p = 0.013), alongside higher beta-blocker dosing and reduced loop diuretic use. Chronic kidney disease and higher baseline GDMT score were negatively associated with GDMT optimization, while higher BMI showed a positive association. In HFmrEF/HFpEF patients, SGLT2 inhibitor use increased from 28.8% to 47.0% (p = 0.010), with a concomitant reduction in loop diuretic prescription and dose.
CONCLUSION: Patients referred to CR after acute HF are mainly male with HFrEF and show substantial comorbidity and treatment complexity. Residential CR represents a key opportunity for GDMT optimization across the HF spectrum.