Management of outpatients by specialists in heart failure: Argentine survey of diagnosis and treatment of heart failure (ENARGIC)

Abstract

Background: The guidelines recommend a "quadruple" therapy to treat heart failure (HF) with ejection fraction ≤40% (HFrEF). However, its adoption by the medical community takes years. Objective: To evaluate the adherence of cardiologists specialized in HF to the current recommendations of medical treatment. Material and methods: A multicenter and prospective electronic survey, accessible through cell phones with a link or QR code, was carried out between March 1 and July 1, 2021. Consecutive outpatients with HFrEF were included, evaluated by 49 members of the HF and Pulmonary Hypertension Committee of the Argentine Federation of Cardiology. Treatment was evaluated according to the use of: 1-ACEI/ARB/ARNI; 2-beta-blockers (BB); 3-aldosterone antagonists (MRA) and 4-SGLT2 inhibitors (SGLT2i) and the number of therapies indicated as mono, double, triple and quadruple were counted. Maximum dose was defined as 100% of the recommended target dose. Results: There were 237 patients included, mean age 62.1 (interquartile range [IQR] 52.5-72) years, 25.3% women, median ejection fraction 30.7% (IQR 26-36), ischemic etiology in 42.2%. The treatment included BB in 98.7% (maximum dose 48.5%); ACEI/ARB/ARNI 97.8% (maximum dose ACEI/ARB 24.9%; ARNI 11.4%); MRA 94.1% (maximum dose 79.3%); and SGLT2i 33.3%. Triple and quadruple therapy was used in 59.9% and 31%, with a maximum dose of 3-4 drugs in 23.3% and 51.4%, respectively (p<0.001). Conclusions: Adherence to HF guidelines by specialists is high, in number and dose of drugs with proven evidence, although it continues to be suboptimal. These data reinforce the role of the HF specialist to optimize treatment.