Physician perceptions, attitudes, and strategies towards implementing guideline-directed medical therapy in heart failure with reduced ejection fraction. A survey of the Heart Failure Association of the ESC and the ESC Council for Cardiology Practice
Savarese, Gianluigi (Karolinska University Hospital and Karolinska Institutet (Suècia))
Lindberg, Felix (Karolinska University Hospital and Karolinska Institutet (Suècia))
Christodorescu, Ruxandra M. (University of Medicine and Pharmacy V (TimiS, Romania))
Ferrini, Marc (CH Saint Joseph and Saint Luc (França))
Kumler, Thomas (Steno Diabetes Center Copenhagen)
Toutoutzas, Konstantinos (University of Athens)
Dattilo, Giuseppe (Department of Biomedical and Dental Sciences and Morphofunctional Imaging. University of Messina)
Bayés-Genís, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Moura, Brenda (Universidade do Porto)
Amir, Offer (Hebrew University)
Petrie, Mark C. (The University Court of the University of Glasgow)
Seferovic, Petar (Medical Faculty University of Belgrade)
Chioncel, O (University of Medicine Carol Davila)
Metra, Metra (University of Brescia)
Coats, Andrew Justin Stewart (Heart Research Institute)
Rosano, Giuseppe M.C. (IRCCS San Raffaele Roma)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	Aims: Recent guidelines recommend four core drug classes (renin-angiotensin system inhibitor/angiotensin receptor-neprilysin inhibitor [RASi/ARNi], beta-blocker, mineralocorticoid receptor antagonist [MRA], and sodium-glucose cotransporter 2 inhibitor [SGLT2i]) for the pharmacological management of heart failure (HF) with reduced ejection fraction (HFrEF). We assessed physicians' perceived (i) comfort with implementing the recent HFrEF guideline recommendations; (ii) status of guideline-directed medical therapy (GDMT) implementation; (iii) use of different GDMT sequencing strategies; and (iv) barriers and strategies for achieving implementation. Methods and results: A 26-question survey was disseminated via bulletin, e-mail and social channels directed to physicians with an interest in HF. Of 432 respondents representing 91 countries, 36% were female, 52% were aged <50 years, and 90% mainly practiced in cardiology (30% HF). Overall comfort with implementing quadruple therapy was high (87%). Only 12% estimated that >90% of patients with HFrEF without contraindications received quadruple therapy. The time required to initiate quadruple therapy was estimated at 1-2 weeks by 34% of respondents, 1 month by 36%, 3 months by 24%, and ≥6 months by 6%. The average respondent favoured traditional drug sequencing strategies (RASi/ARNi with/followed by beta-blocker, and then MRA with/followed by SGLT2i) over simultaneous initiation or SGLT2i-first sequences. The most frequently perceived clinical barriers to implementation were hypotension (70%), creatinine increase (47%), hyperkalaemia (45%) and patient adherence (42%). Conclusions: Although comfort with implementing all four core drug classes in patients with HFrEF was high among physicians, a majority estimated implementation of GDMT in HFrEF to be low. We identified several important perceived clinical and non-clinical barriers that can be targeted to improve implementation.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	European Journal of Heart Failure, Vol. 26 Núm. 6 (june 2024) , p. 1408-1418, ISSN 1879-0844

DOI: 10.1002/ejhf.3214

11 p, 1.8 MB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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