| Title: |
Physician perceptions, attitudes, and strategies towards implementing guideline-directed medical therapy in heart failure with reduced ejection fraction. A survey of the Heart Failure Association of the ESC and the ESC Council for Cardiology Practice |
| Authors: |
Savarese, Gianluigi; Lindberg, Felix; Christodorescu, Ruxandra M.; Ferrini, Marc; Kumler, Thomas; Toutoutzas, Konstantinos; Dattilo, Giuseppe; Bayes-Genis, Antoni; Moura, Brenda; Amir, Offer; Petrie, Mark C.; Seferovic, Petar; Chioncel, Ovidiu; Metra, Marco; Coats, Andrew J.S.; Rosano, Giuseppe M.C. |
| Publisher Information: |
Wiley |
| Publication Year: |
2024 |
| Collection: |
University of Glasgow: Enlighten - Publications |
| Description: |
Aims: Recent guidelines recommend four core drug classes (renin–angiotensin system inhibitor/angiotensin receptor–neprilysin inhibitor [RASi/ARNi], beta-blocker, mineralocorticoid receptor antagonist [MRA], and sodium–glucose cotransporter 2 inhibitor [SGLT2i]) for the pharmacological management of heart failure (HF) with reduced ejection fraction (HFrEF). We assessed physicians' perceived (i) comfort with implementing the recent HFrEF guideline recommendations; (ii) status of guideline-directed medical therapy (GDMT) implementation; (iii) use of different GDMT sequencing strategies; and (iv) barriers and strategies for achieving implementation. Methods and results: A 26-question survey was disseminated via bulletin, e-mail and social channels directed to physicians with an interest in HF. Of 432 respondents representing 91 countries, 36% were female, 52% were aged 90% of patients with HFrEF without contraindications received quadruple therapy. The time required to initiate quadruple therapy was estimated at 1–2 weeks by 34% of respondents, 1 month by 36%, 3 months by 24%, and ≥6 months by 6%. The average respondent favoured traditional drug sequencing strategies (RASi/ARNi with/followed by beta-blocker, and then MRA with/followed by SGLT2i) over simultaneous initiation or SGLT2i-first sequences. The most frequently perceived clinical barriers to implementation were hypotension (70%), creatinine increase (47%), hyperkalaemia (45%) and patient adherence (42%). Conclusions: Although comfort with implementing all four core drug classes in patients with HFrEF was high among physicians, a majority estimated implementation of GDMT in HFrEF to be low. We identified several important perceived clinical and non-clinical barriers that can be targeted to improve implementation. |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| Relation: |
https://eprints.gla.ac.uk/323849/1/323849.pdf; Savarese, G. et al. (2024) Physician perceptions, attitudes, and strategies towards implementing guideline-directed medical therapy in heart failure with reduced ejection fraction. A survey of the Heart Failure Association of the ESC and the ESC Council for Cardiology Practice. European Journal of Heart Failure , 26(6), pp. 1408-1418. (doi:10.1002/ejhf.3214 ) (PMID:38515385) |
| DOI: |
10.1002/ejhf.3214 |
| Availability: |
https://eprints.gla.ac.uk/323849/; https://eprints.gla.ac.uk/323849/1/323849.pdf; https://doi.org/10.1002/ejhf.3214 |
| Rights: |
cc_by_nc_4 |
| Accession Number: |
edsbas.327E39E2 |
| Database: |
BASE |