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Title: | 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 | Authors: | Fauvel, Charles Bonnet, Guillaume MULLENS, Wilfried Giraldo, Clara Ines Saldarriaga Meznar, Anja Zupan Barasa, Anders Tokmakova, Mariya Shchendrygina, Anastasia Costa, Francisco Moscoso Mapelli, Massimo Zemrak, Filip Tops, Laurens F. Jakus, Nina Sultan, Arian Bahouth, Fadel Hadjseyd, Chahr-Eddine Salvat, Muriel Anselmino, Matteo Messroghli, Daniel Weberndorfer, Vanessa Giverts, Ilya Bochaton, Thomas Berthelot, Emmanuelle Legallois, Damien Beauvais, Florence Bauer, Fabrice Lamblin, Nicolas Damy, Thibaud Girerd, Nicolas Sebbag, Laurent Pezel, Theo Cohen-Solal, Alain Rosano, Giuseppe Roubille, Francois Mewton, Nathan |
Issue Date: | 2022 | Publisher: | WILEY | Source: | EUROPEAN JOURNAL OF HEART FAILURE, | Status: | Early view | 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. [GRAPHICS] . | Notes: | Mewton, N (corresponding author), Univ Claude Bernard Lyon 1, Hosp Civils Lyon, Inserm 1407, Heart Failure Dept,Clin Invest Ctr, Lyon, France.; Mewton, N (corresponding author), Univ Claude Bernard Lyon 1, Hosp Civils Lyon, CarMeN 1060, Lyon, France. nathan.mewton@chu-lyon.fr |
Keywords: | Guideline;Heart failure;Pharmacology;Treatment | Document URI: | http://hdl.handle.net/1942/39318 | ISSN: | 1388-9842 | e-ISSN: | 1879-0844 | DOI: | 10.1002/ejhf.2743 | ISI #: | 000898710400001 | Rights: | 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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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.pdf | Early view | 1.78 MB | Adobe PDF | View/Open |
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