Clinical features and GDMT use of European HF patients

21/10/2024

A first coprimary analysis of the ESC HF III Registry presented contemporary HF characteristics by HF phenotype, disease duration, and care setting.

This summary is based on the publication of Lund LH, Crespo-Leiro MG, Laroche C, et al. - Heart failure in Europe: Guideline-directed medical therapy use and decision making in chronic and acute, pre-existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction – the ESC EORP Heart Failure III Registry. Eur J Heart Fail. 2024 Sep 10 [Online ahead of print]. doi: 10.1002/ejhf.3445

Introduction and methods

Background

Although GDMT now has a distinct place in the treatment of patients with HF [1,2], implementation is poor [3,4]. In this regard, it is not clear whether changes in medical therapy depend on HF phenotype, disease duration, and care setting.

Aim of the study

The study aim was to analyze baseline characteristics and GDMT use of HF patients.

Methods

This was the first coprimary analysis of the ESC HF III Registry, which enrolled 10,162 HF patients from 220 centers in 41 European or ESC-affiliated countries in the period November 1, 2018–December 31, 2020 [5]. Of them, 3913 (39%) had acute HF (AHF) and 6217 (61%) were outpatients at the time of enrollment. When stratified by phenotype, 5699 patients (57%) had HFrEF (LVEF ≤40%), 1673 (17%) had HFmrEF (LVEF 41%–49%), and 2647 (26%) had HFpEF (LVEF ≥50%). During the enrollment period, SGLT2/1 inhibitors were not yet indicated specifically for HF patients.

Main results

Baseline characteristics

• Patients with AHF were older than HF outpatients (median age: 70 vs. 66 years; P<0.001), were more commonly women (36% vs. 33%; P=0.006), and more frequently had NYHA class III–IV HF symptoms (80% vs. 32%: P<0.001).

• Of the AHF patients, 97% were hospitalized at the time of enrollment, 2.2% received intravenous treatment in the emergency department, and 0.9% received intravenous therapy in an outpatient clinic.

• Most AHF patients (51%) were treated by a general cardiologist, while most outpatients (48%) received care from an HF specialist (P<0.001 for specialty of enrolling physician).

• The majority of the study population had been hospitalized for HF before, but 26% of the AHF patients and 6% of the outpatients had de novo HF (P<0.001 for HF history).

• Patients with HFpEF less commonly received HF specialist care than patients with HFrEF or HFmrEF (33% vs. 40% vs. 44%), were less likely to have been hospitalized for HF before (54% vs. 64% vs. 63%), and more frequently had de novo HF (18% vs. 12% vs. 11%) (all P<0.001).

GDMT use

• GDMT baseline use, initiation, and discontinuation varied according to care setting (AHF vs. outpatient HF), disease duration (de novo vs. pre-existing HF), and LVEF category.

• For example, after the AHF event or outpatient HF visit, 89% of the HFrEF patients were receiving RAASi treatment, 29% were on ARNIs, 92% were prescribed beta-blockers, 78% were taking MRAs, 6% were being treated with SGLT2/1 inhibitors, and 85% were on loop diuretics.

• Among HFmrEF patients, these proportions were 89%, 10%, 90%, 64%, 5%, and 81%, respectively, whereas they were 77%, 3%, 80%, 48%, 1%, and 80%, respectively, in the HFpEF group.

Conclusion

This first coprimary analysis of the ESC HF III Registry on contemporary HF characteristics and GDMT decisions showed 39% of the patients had AHF at enrollment (almost all of whom were hospitalized), whereas 61% were seen in an outpatient clinic. De novo HF was common in the acute-care setting (26%) but not the outpatient setting (6%). Most patients had HFrEF (57%), followed by HFpEF (26%) and HFmrEF (17%). The authors note the “percentage use of GDMT medications [was greater] than in most other large registries and cohorts and an improvement since the previous ESC HF Long-Term Registry.”

Find this article online at Eur J Heart Fail.

References

  1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022;24:4–131. https://doi.org/10.1002/ejhf.2333
  2. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, et al.; ESC Scientific Document Group. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2024;26:5–17.https://doi.org/10.1002/ejhf.3024
  3. Thorvaldsen T, Benson L, Dahlstrom U, Edner M, Lund LH. Use of evidence-based therapy and survival in heart failure in Sweden 2003-2012. Eur J Heart Fail 2016;18:503–511. https://doi.org/10.1002/ejhf.496
  4.  Ferrari A, Stolfo D, Uijl A, Orsini N, Benson L, Sinagra G, et al. Sex differences in the prognostic role of achieving target doses of heart failure medications: Data from the Swedish Heart Failure Registry. Eur J Heart Fail 2024;26:1101–1110. https://doi.org/10.1002/ejhf.3272
  5. Lund LH, Crespo-Leiro MG, Laroche C, Garcia-Pinilla JM, Bennis A, Vataman EB, et al.; ESC EORP HF III National Leaders and Investigators. Rationale and design of the ESC Heart Failure III Registry – implementation and discovery. Eur J Heart Fail 2023;25:2316–2330. https://doi.org/10.1002/ejhf.3087
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