An interim report from a year in the life of a heart failure patient project: medication adjustment patterns at 3 and 6 months

Background

Heart failure (HF) services play a critical role in optimising medication management. Ongoing adjustments to oral diuretics, guideline-directed medical therapy (GDMT), and advanced interventions such as intravenous (IV) diuretic therapy and metolazone rescue therapy are essential to prevent decompensation, reduce hospitalisations, and improve outcomes. This study aimed to characterise medication adjustment patterns in a real-world HF clinic population as part of an analysis of a year’s experience in the life of a HF patient.

Methods

This is a prospective analysis of sequential patients seen in our HF unit between January and March 2025 who we plan to follow for one year to assess the impact of HF on a patient’s life (‘A Year in the Life of a Heart Failure Patient Project’). Eligible patients included those with confirmed HF diagnosis reviewed for decompensating HF, scheduled HF review, GDMT optimisation, annual review, or following recent hospitalisation. Medication changes are recorded at 3, 6, 9 and 12 month timepoints. This is an interim report focusing on the 3 and 6 month time points. Data collected included demographics, HF phenotype, and specific medication adjustments including oral diuretics, GDMT components, and rescue therapies.

Results

516 patients are included in this analysis: 315 (61.0%) male, 201 (39.0%) female; mean age 73.7±13.1 years; 409 (79.3%) HFrEF, 107 (20.7%) HFpEF (Table 1).

At 3 months, 309 (59.9%) had medication changes: oral diuretics 145 (28.1%), IV diuretics 37 (7.2%), metolazone 23 (4.5%), ACEi/ARB 90 (17.4%), ARNI 87 (16.9%), beta-blockers 75 (14.5%), MRA 132 (25.6%), SGLT2i 68 (13.2%), digoxin 14 (2.7%), ivabradine 6 (1.2%) (Table 2).

At 6 months, 150 (29.1%) had further changes: oral diuretics 72 (14.0%), IV diuretics 14 (2.7%), metolazone 15 (2.9%), ACEi/ARB 27 (5.2%), ARNI 30 (5.8%), beta-blockers 26 (5.0%), MRA 49 (9.5%), SGLT2i 14 (2.7%), digoxin 5 (1.0%), ivabradine 0 (0%) (Table 2).

Conclusions

This real-world analysis demonstrates the dynamic nature of HF medication management, with 59.9% of patients requiring adjustments at 3 months and 29.1% at 6 months. Oral diuretic optimisation remained most frequent (28.1%), reflecting persistent volume challenges. MRA adjustments (25.6%) likely reflect efforts to achieve quadruple GDMT targets. Rescue therapy requirements (IV diuretics 7.2%, metolazone 4.5%) highlight early decompensation interception through specialist monitoring. Low utilisation of digoxin and ivabradine reflects contemporary prescribing patterns. The sustained requirement for medication titration emphasises that HF pharmacotherapy optimisation is an iterative, longitudinal process. These findings underscore the indispensable role of dedicated HF services in achieving GDMT targets and preventing hospitalisations through proactive medication management.Table 1.Patient Demographics (N=516)For image description, please refer to the figure legend and surrounding text.Table 2.Medication Adjustments (N=516)For image description, please refer to the figure legend and surrounding text.