The use of guideline-directed medical therapy for heart failure with reduced ejection fraction is suboptimal

1. Use of guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF) and heart failure with mildly reduced ejection fraction (HFmrEF), and sodium–glucose co-transporter 2 inhibitors (SGLT2i) in heart failure with preserved ejection fraction (HFpEF) remains suboptimal.

Evidence Rating Level: 2 (Good)

Despite advances in heart failure (HF) management, use of quadruple GDMT in HFrEF and SGLT2i in HFmrEF and HFpEF is still lacking. OPTIPHARM-HF is an ongoing prospective, observational, nationwide registry of adult patients with HF in Italy. The primary objective of this registry is to assess prescription and adherence to GDMT and explore reasons for its underuse. 3054 patients (mean [SD] age, 69.2 [12.3] years; 24.8% female) were enrolled. 1720 (56.3%) patients were categorized as HFrEF, 625 (20.5%) as HFmrEF, and 709 (23.2%) as HFpEF. In the HFrEF group, 1555 (90.4%), 322 (18.7%), 1055 (61.3%), 1242 (72.2%) and 1191 (69.2%) patients were treated with beta-blockers, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARB), angiotensin receptor–neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists (MRA), and SGLT2i, respectively. 55.9%, 33.0%, 49.5%, 100% and 100% of patients, respectively, achieved ≥ 50% of the target dose of beta-blockers, ACEi/ARB, ARNI, MRA and SGLT2i. 46.6% of patients received quadruple therapy, 29.9% triple therapy, 15.2% double therapy, 5.6% single therapy and 2.7% of patients were without any therapy. Patients on quadruple therapy were more likely to be younger and had fewer comorbidities. There were also substantial differences between sites. In the HFmrEF group, 552 (88.3%) patients were on beta-blockers, 215 (34.4%) patients were on ACEi/ARB, 306 (49.0%) patients were on ARNI (a total of 521 [83%] on ACEi/ARB/ARNI), 392 (62.7%) were on MRA, and 371 (59.4%) were on SGLT2i. In the HFpEF group, 39% of patients were on SGLT2i. These results highlight suboptimal use and dosing of GDMT across the HF spectrum. Future studies are needed to explore the reasons for these findings and pursue interventions to increase GDMT and enhance HF care.

Click here to read this study in the European Journal of Heart Failure 

Image: PD

©2025 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.