Phenotypic patient profiling for improved implementation of guideline-directed medical therapy: An exploratory analysis in a large real-world chronic heart failure cohort

Radhoe, Sumant P; Clephas, Pascal R.D.; Linssen, Gerard C.M.; Oortman, Remko M.; Smeele, Frank J.; Drimmelen, Annemarie A. van; Schaafsma, Henk-Jan; Westendorp, Paul H.; Rocca, Hans‐Peter Brunner‐La; Brugts, Jasper J.

doi:10.3389/fphar.2023.1081579

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…13 Rosano et al have proposed the use of patient profiling to provide more specific recommendations according to phenotypic HF profile; however, this initiative is new and validation in clinical practice is not available. 16,26 Importantly, the recent STRONG-HF trial provides direct RCT evidence that simultaneous and rapid sequence initiation and titration of GDMT for HF is safe, well tolerated, and effective for reducing death and HF hospitalization. 12 Aside from benefits on the primary clinical outcome, benefits of high-intensity care extended across multiple other endpoint domains.…”

Section: Discussionmentioning

confidence: 99%

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

Clephas,

Malgie,

Schaap

et al. 2023

ESC Heart Failure

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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.

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Section: Discussionmentioning

confidence: 99%

“…have proposed the use of patient profiling to provide more specific recommendations according to phenotypic HF profile; however, this initiative is new and validation in clinical practice is not available. 16 , 26 …”

Section: Discussionmentioning

confidence: 99%

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

Clephas,

Malgie,

Schaap

et al. 2023

ESC Heart Failure

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Translating the 2021 ESC heart failure guideline recommendations in daily practice: Results from a heart failure survey. A scientific statement of the ESC Council for Cardiology Practice and the Heart Failure Association of the ESC

Christodorescu,

Geavlete,

Ferrini

et al. 2024

European J of Heart Fail

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AimsReal‐world data show that guidelines are insufficiently implemented, and particularly guideline‐directed medical therapies (GDMT) are underused in patients with heart failure and reduced ejection fraction (HFrEF) in clinical practice. The Council for Cardiology Practice and the Heart Failure Association of the European Society of Cardiology (ESC) developed a survey aiming to (i) evaluate the perspectives of the cardiology community on the 2021 ESC heart failure (HF) guidelines, (ii) pinpoint disparities in disease management, and (iii) propose strategies to enhance adherence to HF guidelines.Methods and resultsA 22‐question survey regarding the diagnosis and treatment of HFrEF was delivered between March and June 2022. Of 457 physicians, 54% were general cardiologists, 19.4% were HF specialists, 18.9% other cardiac specialists, and 7.7% non‐cardiac specialists. For diagnosis, 52.1% employed echocardiography and natriuretic peptides (NPs), 33.2% primarily used echocardiography, and 14.7% predominantly relied on NPs. The first drug class initiated in HFrEF was angiotensin‐converting enzyme inhibitors/angiotensin receptor–neprilysin inhibitor (ACEi/ARNi) (91.2%), beta‐blockers (BB) (73.8%), mineralocorticoid receptor antagonists (MRAs) (53.4%), and sodium–glucose cotransporter 2 (SGLT2) inhibitors (48.1%). The combination ACEi/ARNi + MRA+ BB was preferred by 39.3% of physicians, ACEi/ARNi + SGLT2 inhibitors + BB by 33.3%, and ACEi/ARNi + BB by 22.2%. The time required to initiate and optimize GDMT was estimated to be <1 month by 8.3%, 1–3 months by 52%, 3–6 months by 31.8%, and >6 months by 7.9%. Compared to general cardiologists, HF specialists/academic cardiologists reported lower estimated time‐to‐initiation, and more commonly preferred a parallel initiation of GDMT rather than a sequential approach.ConclusionParticipants generally followed diagnostic and treatment guidelines, but variations in HFrEF management across care settings or HF specialties were noted. The survey may raise awareness and promote standardized HF care.

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Clinical characteristics, treatment, trajectories and outcome of patients with dilated cardiomyopathy in a national heart failure registry

Carigi,

Gentile,

Gori

et al. 2024

International Journal of Cardiology

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Phenotypic patient profiling for improved implementation of guideline-directed medical therapy: An exploratory analysis in a large real-world chronic heart failure cohort

Cited by 4 publications

References 30 publications

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

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

Translating the 2021 ESC heart failure guideline recommendations in daily practice: Results from a heart failure survey. A scientific statement of the ESC Council for Cardiology Practice and the Heart Failure Association of the ESC

Clinical characteristics, treatment, trajectories and outcome of patients with dilated cardiomyopathy in a national heart failure registry

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