Implementation of recommendations regarding pharmacotherapy optimization in patients with heart failure with reduced ejection fraction undergoing scheduled hospitalization: the HEROES study.

Introduction: The optimization of pharmacotherapy to improve the prognosis of patients with heart failure (HF), guideline-directed medical therapy (GDMT) is one of the main goals of chronic care.

Objectives: To assess the implementation of recommendations regarding GDMT optimization in HF patients undergoing scheduled hospitalization, with a particular emphasis on patients with reduced left ventricular ejection fraction (LVEF).

Patients and methods: The analysis included 412 patients with known LVEF (mean [SD] age 66.7 [13.5] years; 297 men, 115 women) admitted for elective hospitalization, representing a subset of 1422 HEROES study participants. Recruitment across 41 Polish centers took place from April 2022 to May 2024.

Results: The mean (SD) LVEF in the study group was 34.9 (14.4%). Patients with HF with reduced LVEF (HFrEF) constituted 69.7% (n = 287) of the whole group. In this subgroup, angiotensin receptor-neprilysin inhibitor (ARNI)/angiotensin-converting enzyme inhibitor (ACE-I ) / angiotensin receptor blocker (ARB) use increased from 81.5% of subjects at admission to 88.9% at discharge, beta-blocker use increased from 85.0% to 94.4%, mineralocorticoid receptor antagonist (MRA) use increased from 69.7% to 94.4%, and SGLT2i from 59.2% to 83.6%. ARNI / ACE-I / ARB therapy was optimized in 36.2% of the subjects, while the rates of optimization were 24.7%, 27.2%, and 24.4% for beta-blockers, MRA, and sodium glucose cotransporter-2inhibitor (SGLT2i), respectively. However, only 64 patients (22.3%) attained the 4-pillar GDMT of SGLT2i, ARNI/ACE-I/ARB, beta-blockers and MRA at doses ≥50%.

Conclusions: In the Polish multicenter HEROES registry over 80% of patients with HFrEF were discharged on four-pillar GDMT. Nevertheless, the attainment of target high-dose GDMT remains suboptimal. These findings provide new insights into the variability of GDMT implementation at a national level and underline the need for strategies to improve dosing optimization.