%0 Journal Article
%T Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE-HF study.
%A Malgie J
%A Wilde MI
%A Clephas PRD
%A Emans ME
%A Koudstaal S
%A Schaap J
%A Mosterd A
%A van Ramshorst J
%A Wardeh AJ
%A van Wijk S
%A van den Heuvel M
%A Wierda E
%A Borleffs CJW
%A Saraber C
%A Beeres SLMA
%A van Kimmenade R
%A Jansen Klomp W
%A Denham R
%A da Fonseca CA
%A Klip IT
%A Manintveld OC
%A van der Boon RMA
%A van Ofwegen CEE
%A Yilmaz A
%A Pisters R
%A Linssen GCM
%A Faber N
%A van Heerebeek L
%A van de Swaluw JEC
%A Bouhuijzen LJ
%A Post MC
%A Kuijper AFM
%A Wu KW
%A van Beek EA
%A Hesselink T
%A Kleijn L
%A Kurvers MJM
%A Tio RA
%A Langerveld J
%A van Dalen BM
%A van Eck JWM
%A Handoko ML
%A Hermans WRM
%A Koornstra-Wortel HJJ
%A Szymanski MK
%A Rooker D
%A Tandjung K
%A Eijsbouts SCM
%A Asselbergs FW
%A van der Meer P
%A Brunner-La Rocca HP
%A de Boer RA
%A Brugts JJ
%J Eur J Heart Fail
%V 26
%N 7
%D 2024 Jul 12
%M 38734980
%F 17.349
%R 10.1002/ejhf.3267
%X <B>OBJECTIVE: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.