Impact of an educational intervention on pharmacological management of HFrEF in Italy: results from the multicenter OpTIMa-HF registry
M Di Santo, P Severino, G Galasso, F Guarnaccia, A Lillo, S Nodari, M Senni, P Agostoni, P Calabro', F Grigioni, G Sinagra, G Patti, F Marzano, P Perrone-Filardi, S PaolilloAbstract
Background/Introduction
The most recent European guidelines for the management of chronic heart failure (HF) recommend, in patients with HF with reduced ejection fraction (HFrEF), a pharmacological approach based on four foundational drugs, to be initiated rapidly and subsequently up-titrated to modify disease progression.
Purpose
The aim of the OpTIMa-HF registry is to collect data on patients with HF across different healthcare settings. The present analysis focuses on patients with HFrEF enrolled during the prospective phase (T1), compared with those included in the retrospective phase (T0), in order to assess the impact of an educational intervention on therapeutic decision-making and on guideline-directed medical treatment (GDMT) implementation in routine clinical practice.
Methods
OpTIMa-HF is a multicentre, observational registry conducted in 29 Italian centres, including hospital-based and community-based outpatient clinics specialised in HF care. The study protocol consisted of three phases: a retrospective data collection (T0, January–October 2022), an educational programme targeted to cardiologists, and a subsequent prospective enrolment of consecutive patients (T1, September–November 2023). Data of patients with HFrEF enrolled during T1 were analysed and compared with those included during T0. The analysis focused on prescription rates of GDMT, as well as on treatment combinations, particularly quadruple therapy.
Results
A total of 1,390 patients with HFrEF were analysed in T0 and 1,292 in T1. Patients enrolled in T1 were slightly older (70.5 vs 69.5 years; p=0.032) and had a lower prevalence of ischaemic aetiology (58.4% vs 65.3%; p<0.001) and atrial fibrillation (19.2% vs 28.7%; p<0.001). Compared with T0, T1 was associated with a significant increase in prescriptions of angiotensin receptor–neprilysin inhibitors (ARNI, 72.2% vs 75.8%; p=0.035), mineralocorticoid receptor antagonists (MRA, 75.8% vs 81.4%; p=0.010) and sodium–glucose co-transporter-2 inhibitors (SGLT2i, 63.2% vs 80.3%; p<0.001). The proportion of patients receiving quadruple therapy increased to 53.4% (vs 40.6% at T0; p<0.001). The percentage of patients not treated with ARNI or SGLT2i despite the absence of contraindications decreased, particularly for SGLT2i (31.8% vs 17.1%; p<0.001). No significant differences were observed between phases in the optimisation of target doses of ARNI, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARB), beta-blockers and MRA.
Conclusions
The educational intervention implemented within the OpTIMa-HF registry contributed to a closer alignment of real-world clinical practice with European guideline recommendations, with increased prescription of ARNI, MRA and especially SGLT2 inhibitors, as well as greater use of quadruple therapy. However, there remains room for improvement in the optimisation of target doses of cornerstone therapies for HFrEF.