Implementation of guideline-directed pharmacotherapy in hospitalized and outpatient heart failure care: a web-based survey
M Tokmakova, E Trendafilova, S Tisheva, P Gatzov, Y Yotov, N Runev, A Vladimirova, R RaychevaAbstract
Background
Heart failure (HF) frequently coexists with cardiovascular, renal, and metabolic comorbidities, shaping clinical presentation and management. Uptake of guideline-directed therapy for HF varies in everyday practice and may differ substantially between inpatient and outpatient settings.
Purpose
To assess and compare pharmacotherapy patterns in hospitalized versus outpatient HF care.
Methods
A web-based cross-sectional survey developed by a steering committee and completed by cardiologists collected patient-level medication data for consecutive HF patients prospectively managed between 1 June and 10 July 2025. Medication classes were recorded as present/absent. Groups were compared using chi-square/Fisher’s exact tests and z-tests for proportions; p<0.05 was significant.
Results
Among 1,438 patients commonly used therapies included beta-blockers (85.8%), sodium–glucose cotransporter-2 (SGLT-2) inhibitors (82.1%), loop diuretics (79.0%), mineralocorticoid receptor antagonists (MRA) (58.4%), angiotensin-converting enzyme inhibitor (ACEi) (44.5%), angiotensin receptor blocker (ARB) (31.6%) and angiotensin receptor–neprilysin inhibitor (ARNI) (22.8%). SGLT-2 inhibitor use was lower in hospitalized than ambulatory patients (74.1% vs 85.9%; p<0.001). ACE inhibitor use was higher in hospitalized patients (48.4% vs 42.6%; p=0.040), while ARNI use was lower (19.3% vs 24.5%; p=0.027). MRA use was also lower among hospitalized patients (53.7% vs 60.7%; p=0.013), as was ivabradine use (1.5% vs 4.6%; p=0.003). Among hospitalized patients at discharge, prescriptions included SGLT-2 inhibitors (80.7%), beta-blockers (78.4%), MRA (56.5%), and ACE inhibitor/ARB or ARNI (67.9%).
Conclusion
Substantial setting-related differences in pharmacotherapy were observed, including lower use of SGLT-2 inhibitors and MRAs among hospitalized patients. Strengthening initiation and continuity across the inpatient–outpatient transition could reduce avoidable treatment gaps.For image description, please refer to the figure legend and surrounding text.