Abstract：
OBJECTIVE: Despite clear guideline recommendations for initiating four drug classes in all patients with heart failure (HF) with reduced ejection fraction (HFrEF) and the availability of rapid titration schemes, information on real-world implementation lags behind. Closely following the 2021 ESC HF guidelines and 2023 focused update, the TITRATE-HF study started to prospectively investigate the use, sequencing, and titration of guideline-directed medical therapy (GDMT) in HF patients, including the identification of implementation barriers.
RESULTS: TITRATE-HF is an ongoing long-term HF registry conducted in the Netherlands. Overall, 4288 patients from 48 hospitals were included. Among these patients, 1732 presented with de novo, 2240 with chronic, and 316 with worsening HF. The median age was 71 years (interquartile range [IQR] 63-78), 29% were female, and median ejection fraction was 35% (IQR 25-40). In total, 44% of chronic and worsening HFrEF patients were prescribed quadruple therapy. However, only 1% of HFrEF patients achieved target dose for all drug classes. In addition, quadruple therapy was more often prescribed to patients treated in a dedicated HF outpatient clinic as compared to a general cardiology outpatient clinic. In each GDMT drug class, 19% to 36% of non-use in HFrEF patients was related to side-effects, intolerances, or contraindications. In the de novo HF cohort, 49% of patients already used one or more GDMT drug classes for other indications than HF.
CONCLUSIONS: This first analysis of the TITRATE-HF study reports relatively high use of GDMT in a contemporary HF cohort, while still showing room for improvement regarding quadruple therapy. Importantly, the use and dose of GDMT were suboptimal, with the reasons often remaining unclear. This underscores the urgency for further optimization of GDMT and implementation strategies within HF management.
RESULTS: TITRATE-HF is an ongoing long-term HF registry conducted in the Netherlands. Overall, 4288 patients from 48 hospitals were included. Among these patients, 1732 presented with de novo, 2240 with chronic, and 316 with worsening HF. The median age was 71 years (interquartile range [IQR] 63-78), 29% were female, and median ejection fraction was 35% (IQR 25-40). In total, 44% of chronic and worsening HFrEF patients were prescribed quadruple therapy. However, only 1% of HFrEF patients achieved target dose for all drug classes. In addition, quadruple therapy was more often prescribed to patients treated in a dedicated HF outpatient clinic as compared to a general cardiology outpatient clinic. In each GDMT drug class, 19% to 36% of non-use in HFrEF patients was related to side-effects, intolerances, or contraindications. In the de novo HF cohort, 49% of patients already used one or more GDMT drug classes for other indications than HF.
CONCLUSIONS: This first analysis of the TITRATE-HF study reports relatively high use of GDMT in a contemporary HF cohort, while still showing room for improvement regarding quadruple therapy. Importantly, the use and dose of GDMT were suboptimal, with the reasons often remaining unclear. This underscores the urgency for further optimization of GDMT and implementation strategies within HF management.
摘要：
目的：尽管在所有射血分数（HFrEF）降低的心力衰竭（HF）患者中启动四种药物的明确指南建议和快速滴定方案的可用性，关于现实世界实施的信息滞后。密切关注2021年ESCHF指南和2023年重点更新，Titrate-HF研究开始前瞻性地调查其用途，测序,测序和指南指导药物治疗（GDMT）在HF患者的滴定，包括识别实施障碍。
结果：Titrate-HF是在荷兰进行的长期HF注册。总的来说,包括来自48家医院的4288名患者。在这些患者中,1732年以从头呈现，2240慢性，和316恶化的HF。中位年龄为71岁（四分位距[IQR]63-78），29%是女性，中位射血分数为35%（IQR25-40）。总的来说,44％的慢性和恶化的HFrEF患者接受了四联疗法。然而,只有1%的HFrEF患者达到了所有药物类别的目标剂量.此外,与普通心脏病门诊部相比,在专门的HF门诊部接受治疗的患者更常用四联疗法.在每个GDMT药物类别中，19％至36％的HFrEF患者不使用与副作用有关，不容忍,或禁忌症。在从头HF队列中，49％的患者已经使用一种或多种GDMT药物类别用于HF以外的其他适应症。
结论：对TITRATE-HF研究的首次分析报告了在当代HF队列中GDMT的使用相对较高，在四联疗法方面仍有改善的空间。重要的是,GDMT的使用和剂量次优，原因往往不清楚。这强调了进一步优化GDMT和HF管理中的实施策略的紧迫性。
结果：Titrate-HF是在荷兰进行的长期HF注册。总的来说,包括来自48家医院的4288名患者。在这些患者中,1732年以从头呈现，2240慢性，和316恶化的HF。中位年龄为71岁（四分位距[IQR]63-78），29%是女性，中位射血分数为35%（IQR25-40）。总的来说,44％的慢性和恶化的HFrEF患者接受了四联疗法。然而,只有1%的HFrEF患者达到了所有药物类别的目标剂量.此外,与普通心脏病门诊部相比,在专门的HF门诊部接受治疗的患者更常用四联疗法.在每个GDMT药物类别中，19％至36％的HFrEF患者不使用与副作用有关，不容忍,或禁忌症。在从头HF队列中，49％的患者已经使用一种或多种GDMT药物类别用于HF以外的其他适应症。
结论：对TITRATE-HF研究的首次分析报告了在当代HF队列中GDMT的使用相对较高，在四联疗法方面仍有改善的空间。重要的是,GDMT的使用和剂量次优，原因往往不清楚。这强调了进一步优化GDMT和HF管理中的实施策略的紧迫性。
