Sequencing and titrating approach of therapy in heart failure with reduced ejection fraction following the 2021 European Society of Cardiology guidelines: an international cardiology survey - Facteurs de risques et déterminants moléculaires des maladies liées au vieillissement (U 1167) Accéder directement au contenu
Article Dans Une Revue European Journal of Heart Failure Année : 2023

Sequencing and titrating approach of therapy in heart failure with reduced ejection fraction following the 2021 European Society of Cardiology guidelines: an international cardiology survey

Anders Barasa
  • Fonction : Auteur
Fadel Bahouth
  • Fonction : Auteur
Ilya Giverts
  • Fonction : Auteur
Thomas Bochaton
  • Fonction : Auteur
Pierre Yves Courand
  • Fonction : Auteur
Emmanuelle Berthelot
  • Fonction : Auteur
Damien Legallois
  • Fonction : Auteur
Florence Beauvais
  • Fonction : Auteur
Fabrice Bauer
  • Fonction : Auteur
Thibaud Damy
  • Fonction : Auteur
Nicolas Girerd
  • Fonction : Auteur
Laurent Sebbag
  • Fonction : Auteur
Théo Pezel
  • Fonction : Auteur
Alain Cohen-Solal
  • Fonction : Auteur
Giuseppe Rosano
  • Fonction : Auteur
François Roubille
  • Fonction : Auteur
Nathan Mewton
  • Fonction : Auteur

Résumé

Abstract Aims In symptomatic patients with heart failure and reduced ejection fraction (HFrEF), recent international guidelines recommend initiating four major therapeutic classes rather than sequential initiation. It remains unclear how this change in guidelines is perceived by practicing cardiologists versus heart failure (HF) specialists. Methods and results An independent academic web‐based survey was designed by a group of HF specialists and posted by email and through various social networks to a broad community of cardiologists worldwide 1 year after the publication of the latest European HF guidelines. Overall, 615 cardiologists (38 [32–47] years old, 63% male) completed the survey, of which 58% were working in a university hospital and 26% were HF specialists. The threshold to define HFrEF was ≤40% for 61% of the physicians. Preferred drug prescription for the sequential approach was angiotensin‐converting enzyme inhibitors or angiotensin receptor–neprilysin inhibitors first (74%), beta‐blockers second (55%), mineralocorticoid receptor antagonists third (52%), and sodium–glucose cotransporter 2 inhibitors (53%) fourth. Eighty‐four percent of participants felt that starting all four classes was feasible within the initial hospitalization, and 58% felt that titration is less important than introducing a new class. Age, status in training, and specialization in HF field were the principal characteristics that significantly impacted the answers. Conclusion In a broad international cardiology community, the ‘historical approach’ to HFrEF therapies remains the preferred sequencing approach. However, accelerated introduction and uptitration are also major treatment goals. Strategy trials in treatment guidance are needed to further change practices.
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hal-04277773 , version 1 (03-06-2024)

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Charles Fauvel, Guillaume Bonnet, Wilfried Mullens, Clara Ines Saldarriaga Giraldo, Anja Zupan Mežnar, et al.. Sequencing and titrating approach of therapy in heart failure with reduced ejection fraction following the 2021 European Society of Cardiology guidelines: an international cardiology survey. European Journal of Heart Failure, 2023, 25 (2), pp.213-222. ⟨10.1002/ejhf.2743⟩. ⟨hal-04277773⟩
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