Background Despite guidelines recommendations, guideline-directed medical therapy (GDMT) remains underused and underdosed in patients with heart failure (HF) across the ejection fraction (EF) spectrum. Aim To evaluate GDMT use, dosing, and implementation in a contemporary, nationwide HF cohort. Methods The OPTIPHARM-HF(NCT06192524) is a prospective, multicenter, observational study enrolling adult with HF, across 32 Italian HF centers. Clinical characteristics, medical therapy prevalence and change after first visit have been assessed in patients with reduced (HFrEF:EF ≤40%), mildly reduced (HFmrEF:EF 40–49%), and preserved EF (HFpEF:EF ≥50%). Results From September 2022 to December 2024, 3054 patients (mean age 69±12 years, 25% females) were enrolled: 56% with HFrEF, 21% with HFmrEF, and 23% with HFpEF. Among HFrEF, prescription frequencies were:90% for beta-blockers;19% for angiotensin-converting enzyme inhibitors(ACEI)/angiotensin II receptor blockers(ARB);61% for angiotensin receptor-neprilysin inhibitors(ARNI);72% for mineralocorticoid receptor antagonists(MRA); and 69% for sodium-glucose cotransporter-2 inhibitors(SGLT2i). Less than 60% achieved ≥50% of target doses. Quadruple therapy was received by 47% of the patients. After first visit there was an increase in prescription of all classes of drugs, and titration to quadruple therapy was attained in 64% (p< 0.001). Among HFmrEF, 88% were on beta-blockers, 34% on ACEI/ARB, 49% on ARNI, 63% on MRA, and 59% on SGLT2i. In the HFpEF group, 76% were on beta-blockers, 49% on ACEI/ARB, 18% on ARNI, 49% on MRA and 40% on SGLT2i. After the first visit, SGLT2i prescription significantly increased both in HFmrEF (74%,p<0.001) and HFpEF (54%,p<0.001). Conclusion Use of GDMT remains suboptimal across the EF spectrum although the adoption of quadruple GDMT in HFrEF and of SGLT2i in HFmrEF and HFpEF increased in recent years.
Contemporary Medical Therapy for Heart Failure Across the Ejection Fraction Spectrum: The OPTIPHARM-HF registry / Inciardi, Riccardo M.; Volterrani, Maurizio; Savarese, Gianluigi; Vaduganathan, Muthiah; Oriecuia, Chiara; Lombardi, Carlo M.; Gussago, Cristina; Agostoni, Piergiuseppe; Ameri, Pietro; Armentaro, Giuseppe; Arzilli, Chiara; Aspromonte, Nadia; Attanasio, Andrea; Badagliacca, Roberto; 1, Lucia Barbieri; Paolo Bocchino, Pier; Bursi, Francesca; Cameli 18, Matteo; Canonero, Martino; Campodonico, Jeness S.; Capovilla, Teresa; Carluccio, Erberto; Carugo, Stefano; Castiglione, Vincenzo; Catapano, Dario; Cipriani, Manlio; Correale, Michele; D'Amario, Domenico; De Caterina, Raffaele; De Ferrari, Gaetano M.; D'Elia, Emilia; Di Odoardo, Luca; Emdin, Michele; Falco, Luigi; Ferrante, Giulia; Fornaro, Alessandra; Fornaro, Paolo; Guastamiglio Marco Guazzi, Gionata; Iacoviello, Massimo; Imazio, Massimo; Incaminato, Enrico; Teresa La Rovere, Maria; Leonardi, Sergio; Maccallini, Marta; Mandoli, Giulia E.; Masarone, Daniele; Masetti, Marco; Mazzoni, Alberto; Mazzotta, Marta; Merlo, Marco; Moschini, Luigi; Novarese, Filippo; Palazzuoli, Alberto; Pastore, Maria C.; Patti, Giuseppe; Pedretti, Roberto F. E.; Pidello, Stefano; Piepoli, Massimo F.; Pinto, Giuseppe; Potena, Luciano; Raineri, Claudia; Rubbo, Filippo M.; Sabatino, Mario; Salzano, Andrea; Sciacqua, Angela; Senni, Michele; Severino, Paolo; Sinagra, Gianfranco; Sposato, Barbara; Taddei, Stefano; Valleggi, Alessandro; Vignati, Carlo; Vizza, Dario; Specchia, Claudia; Rosano, Giuseppe; Metra, Marco. - In: EUROPEAN JOURNAL OF HEART FAILURE. - ISSN 1879-0844. - (2025).
Contemporary Medical Therapy for Heart Failure Across the Ejection Fraction Spectrum: The OPTIPHARM-HF registry
Roberto Badagliacca;Paolo Severino;Dario Vizza;
2025
Abstract
Background Despite guidelines recommendations, guideline-directed medical therapy (GDMT) remains underused and underdosed in patients with heart failure (HF) across the ejection fraction (EF) spectrum. Aim To evaluate GDMT use, dosing, and implementation in a contemporary, nationwide HF cohort. Methods The OPTIPHARM-HF(NCT06192524) is a prospective, multicenter, observational study enrolling adult with HF, across 32 Italian HF centers. Clinical characteristics, medical therapy prevalence and change after first visit have been assessed in patients with reduced (HFrEF:EF ≤40%), mildly reduced (HFmrEF:EF 40–49%), and preserved EF (HFpEF:EF ≥50%). Results From September 2022 to December 2024, 3054 patients (mean age 69±12 years, 25% females) were enrolled: 56% with HFrEF, 21% with HFmrEF, and 23% with HFpEF. Among HFrEF, prescription frequencies were:90% for beta-blockers;19% for angiotensin-converting enzyme inhibitors(ACEI)/angiotensin II receptor blockers(ARB);61% for angiotensin receptor-neprilysin inhibitors(ARNI);72% for mineralocorticoid receptor antagonists(MRA); and 69% for sodium-glucose cotransporter-2 inhibitors(SGLT2i). Less than 60% achieved ≥50% of target doses. Quadruple therapy was received by 47% of the patients. After first visit there was an increase in prescription of all classes of drugs, and titration to quadruple therapy was attained in 64% (p< 0.001). Among HFmrEF, 88% were on beta-blockers, 34% on ACEI/ARB, 49% on ARNI, 63% on MRA, and 59% on SGLT2i. In the HFpEF group, 76% were on beta-blockers, 49% on ACEI/ARB, 18% on ARNI, 49% on MRA and 40% on SGLT2i. After the first visit, SGLT2i prescription significantly increased both in HFmrEF (74%,p<0.001) and HFpEF (54%,p<0.001). Conclusion Use of GDMT remains suboptimal across the EF spectrum although the adoption of quadruple GDMT in HFrEF and of SGLT2i in HFmrEF and HFpEF increased in recent years.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
