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

Gianluigi Savarese, Felix Lindberg, Ruxandra M. Christodorescu, Marc Ferrini, Thomas Kumler, Konstantinos Toutoutzas, Giuseppe Dattilo, Antoni Bayes-Genis, Brenda Moura, Offer Amir, Mark C. Petrie, Petar Seferovic, Ovidiu Chioncel, Marco Metra, Andrew J.S. Coats, Giuseppe M.C. Rosano

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Aims: Recent guidelines recommend four core drug classes (renin–angiotensin system/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.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Early online date22 Mar 2024
DOIs
StatePublished - Jun 2024
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Keywords

  • Guideline-directed medical therapy
  • Heart failure with reduced ejection fraction
  • Treatment implementation

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