Guideline implementation, drug sequencing, and quality of care in heart failure: design and rationale of TITRATE‐HF

Abstract

AimsCurrent heart failure (HF) guidelines recommend to prescribe four drug classes in patients with HF with reduced ejection fraction (HFrEF). A clear challenge exists to adequately implement guideline‐directed medical therapy (GDMT) regarding the sequencing of drugs and timely reaching target dose. It is largely unknown how the paradigm shift from a serial and sequential approach for drug therapy to early parallel application of the four drug classes will be executed in daily clinical practice, as well as the reason clinicians may not adhere to new guidelines. We present the design and rationale for the real‐world TITRATE‐HF study, which aims to assess sequencing strategies for GDMT initiation, dose titration patterns (order and speed), intolerance for GDMT, barriers for implementation, and long‐term outcomes in patients with de novo, chronic, and worsening HF.Methods and resultsA total of 4000 patients with HFrEF, HF with mildly reduced ejection fraction, and HF with improved ejection fraction will be enrolled in >40 Dutch centres with a follow‐up of at least 3 years. Data collection will include demographics, physical examination and vital parameters, electrocardiogram, laboratory measurements, echocardiogram, medication, and quality of life. Detailed information on titration steps will be collected for the four GDMT drug classes. Information will include date, primary reason for change, and potential intolerances. The primary clinical endpoints are HF‐related hospitalizations, HF‐related urgent visits with a need for intravenous diuretics, all‐cause mortality, and cardiovascular mortality.ConclusionsTITRATE‐HF is a real‐world multicentre longitudinal registry that will provide unique information on contemporary GDMT implementation, sequencing strategies (order and speed), and prognosis in de novo, worsening, and chronic HF patients.

Contemporary guideline‐directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE‐HF study

“…The methods of TITRATE-HF have been published earlier. 10 In brief, TITRATE-HF is an ongoing prospective observational HF registry in the Netherlands, aiming at long-term follow-up for up to 10 years of the entire cohort. Between June 2022 and February 2024, the study aimed to consecutively enrol at least 4000 patients with HFrEF, HF with mildly reduced ejection fraction (HFmrEF), and HF with improved ejection fraction (HFimpEF).…”

What we claim to do and what we really do – a discrepancy in heart failure treatment

“…With respect to this topic, the TITRATE-HF longitudinal registry will provide new data on contemporary GDMT implementation, sequencing strategies (order and speed), and prognosis in de novo, worsening, and chronic HF patients. 15…”