TY - JOUR

T1 - Sequencing and titrating approach of therapy in heart failure with reduced ejection fraction following the 2021 European Society of Cardiology guidelines

T2 - an international cardiology survey

AU - Fauvel, Charles

AU - Bonnet, Guillaume

AU - Mullens, Wilfried

AU - Giraldo, Clara Ines Saldarriaga

AU - Mežnar, Anja Zupan

AU - Barasa, Anders

AU - Tokmakova, Mariya

AU - Shchendrygina, Anastasia

AU - Costa, Francisco Moscoso

AU - Mapelli, Massimo

AU - Zemrak, Filip

AU - Tops, Laurens F.

AU - Jakus, Nina

AU - Sultan, Arian

AU - Bahouth, Fadel

AU - Hadjseyd, Chahr-eddine

AU - Salvat, Muriel

AU - Anselmino, Matteo

AU - Messroghli, Daniel

AU - Weberndörfer, Vanessa

AU - Giverts, Ilya

AU - Bochaton, Thomas

AU - Courand, Pierre Yves

AU - Berthelot, Emmanuelle

AU - Legallois, Damien

AU - Beauvais, Florence

AU - Bauer, Fabrice

AU - Lamblin, Nicolas

AU - Damy, Thibaud

AU - Girerd, Nicolas

AU - Sebbag, Laurent

AU - Pezel, Théo

AU - Cohen-Solal, Alain

AU - Rosano, Giuseppe

AU - Roubille, François

AU - Mewton, Nathan

N1 - Publisher Copyright: © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PY - 2023

Y1 - 2023

N2 - Aims: In symptomatic patients with heart failure and reduced ejection fraction (HFrEF), recent international guidelines recommend initiating four major therapeutic classes rather than sequential initiation. It remains unclear how this change in guidelines is perceived by practicing cardiologists versus heart failure (HF) specialists. Methods and results: An independent academic web-based survey was designed by a group of HF specialists and posted by email and through various social networks to a broad community of cardiologists worldwide 1 year after the publication of the latest European HF guidelines. Overall, 615 cardiologists (38 [32–47] years old, 63% male) completed the survey, of which 58% were working in a university hospital and 26% were HF specialists. The threshold to define HFrEF was ≤40% for 61% of the physicians. Preferred drug prescription for the sequential approach was angiotensin-converting enzyme inhibitors or angiotensin receptor–neprilysin inhibitors first (74%), beta-blockers second (55%), mineralocorticoid receptor antagonists third (52%), and sodium–glucose cotransporter 2 inhibitors (53%) fourth. Eighty-four percent of participants felt that starting all four classes was feasible within the initial hospitalization, and 58% felt that titration is less important than introducing a new class. Age, status in training, and specialization in HF field were the principal characteristics that significantly impacted the answers. Conclusion: In a broad international cardiology community, the ‘historical approach’ to HFrEF therapies remains the preferred sequencing approach. However, accelerated introduction and uptitration are also major treatment goals. Strategy trials in treatment guidance are needed to further change practices.

AB - Aims: In symptomatic patients with heart failure and reduced ejection fraction (HFrEF), recent international guidelines recommend initiating four major therapeutic classes rather than sequential initiation. It remains unclear how this change in guidelines is perceived by practicing cardiologists versus heart failure (HF) specialists. Methods and results: An independent academic web-based survey was designed by a group of HF specialists and posted by email and through various social networks to a broad community of cardiologists worldwide 1 year after the publication of the latest European HF guidelines. Overall, 615 cardiologists (38 [32–47] years old, 63% male) completed the survey, of which 58% were working in a university hospital and 26% were HF specialists. The threshold to define HFrEF was ≤40% for 61% of the physicians. Preferred drug prescription for the sequential approach was angiotensin-converting enzyme inhibitors or angiotensin receptor–neprilysin inhibitors first (74%), beta-blockers second (55%), mineralocorticoid receptor antagonists third (52%), and sodium–glucose cotransporter 2 inhibitors (53%) fourth. Eighty-four percent of participants felt that starting all four classes was feasible within the initial hospitalization, and 58% felt that titration is less important than introducing a new class. Age, status in training, and specialization in HF field were the principal characteristics that significantly impacted the answers. Conclusion: In a broad international cardiology community, the ‘historical approach’ to HFrEF therapies remains the preferred sequencing approach. However, accelerated introduction and uptitration are also major treatment goals. Strategy trials in treatment guidance are needed to further change practices.

KW - Guideline

KW - Heart failure

KW - Pharmacology

KW - Treatment

U2 - 10.1002/ejhf.2743

DO - 10.1002/ejhf.2743

M3 - Journal article

C2 - 36404398

AN - SCOPUS:85142657350

VL - 25

SP - 213

EP - 222

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1567-4215

IS - 2

ER -