TY - JOUR
T1 - 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
AU - Savarese, Gianluigi
AU - Lindberg, Felix
AU - Christodorescu, Ruxandra M
AU - Ferrini, Marc
AU - Kumler, Thomas
AU - Toutoutzas, Konstantinos
AU - Dattilo, Giuseppe
AU - Bayes-Genis, Antoni
AU - Moura, Brenda
AU - Amir, Offer
AU - Petrie, Mark C
AU - Seferovic, Petar
AU - Chioncel, Ovidiu
AU - Metra, Marco
AU - Coats, Andrew J S
AU - Rosano, Giuseppe M C
N1 - © 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2024/6
Y1 - 2024/6
N2 - 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.
AB - 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.
KW - Adrenergic beta-Antagonists/therapeutic use
KW - Angiotensin Receptor Antagonists/therapeutic use
KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
KW - Attitude of Health Personnel
KW - Cardiology
KW - Female
KW - Guideline Adherence
KW - Heart Failure/drug therapy
KW - Humans
KW - Male
KW - Middle Aged
KW - Mineralocorticoid Receptor Antagonists/therapeutic use
KW - Physicians
KW - Practice Guidelines as Topic
KW - Practice Patterns, Physicians'
KW - Societies, Medical
KW - Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
KW - Stroke Volume/physiology
KW - Surveys and Questionnaires
KW - Treatment implementation
KW - Guideline-directed medical therapy
KW - Heart failure with reduced ejection fraction
UR - http://www.scopus.com/inward/record.url?scp=85189106112&partnerID=8YFLogxK
U2 - 10.1002/ejhf.3214
DO - 10.1002/ejhf.3214
M3 - Journal article
C2 - 38515385
SN - 1388-9842
VL - 26
SP - 1408
EP - 1418
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 6
ER -