Impacts of a rapid up-titration programme of guideline-directed medical therapy on quality of life: patient-reported outcomes from a multicentre heart failure study

Introduction

Rapid up-titration (RT) of guideline-directed medical therapy (GDMT) in patients with heart failure (HF) is crucial as highlighted by the 2023 ESC HF guidelines. Although RT programmes (RTPs) are increasingly implemented in clinical practice, their impact on patient-reported quality of life (QoL) outcomes and patient satisfaction in the early post-discharge period remains incompletely characterized.

Aims

To assess the effects of a multicentre 6-week RTP of GDMT on QoL parameters.

Patients and methods: This multicentre, observational study involved 111 patients (79% male; median age: 57 (24-82); HF with reduced ejection fraction (HFrEF): 91%; de novo diagnosis of HF: 65%; New York Heart Association [NYHA] functional class II-IV) who participated in a 6-week RTP with regular follow-up visits in five national secondary and tertiary cardiology centres and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) at baseline and 6 weeks after discharge. Participants received GDMT according to RTP.

Results

The overall KCCQ-12 score improved significantly (57 [50-62] vs. 34 [24-45]; P<0.0001; after RTP vs. before RTP, consequently), with 84% of patients achieving a clinically meaningful improvement (≥5 point-increase). Patients who received 100% target-dose (TD) quadruple therapy (QT: RASi, βB, MRA, SGLT2i - 47%) were more likely to achieve clinically meaningful improvement in KCCQ-12 overall score compared with those receiving <100% TD QT (92% vs. 76%; P=0.0369). Significant improvements were also observed in the physical limitation score (questions 1a-1c: 14 [12-15] vs. 9 [6-11]; P<0.0001), the QoL score (questions 6-7: 8 [7-10] vs. 4 [3-6]; P<0.0001), symptom frequency score (questions 2-5: 22 [19-24] vs. 13 [9-18]; P<0.0001), and clinical summary score (CSS: 44 [38-47] vs. 27 [18-33]; P<0.0001).

Conclusion

This multicentre observational study demonstrates that a 6-week RTP of GDMT leads to significant improvements in QoL and overall KCCQ-12 scores. Beyond routinely assessed echocardiographic and laboratory parameters, patient-reported outcomes provide important confirmation of the clinical benefits of RTP. Improved QoL may enhance patient satisfaction and adherence, thereby supporting long-term treatment compliance and follow-up.