Use of guideline-directed medical therapy in outpatients with heart failure in real-world practice: a subanalysis of PRIORITY-HF study

Material and methods. This retrospective analysis of contraindication rate to four GDMT classes was performed in 19981 outpatients with HF included in the PRIORITYHF study. The changes of drug prescription and titration were assessed in a cohort of patients without contraindications and who underwent visits at 6 and 12 months of follow-up. The multivariate mixed logistic regression was used to determine factors associated with the prescription and higher doses of GDMT drugs.

Results. A total of 1943 (9,7%) study participants had baseline contraindications to at least one GDMT class. Among the 15575 patients without contraindications who completed all study visits, quadruple therapy coverage increased from 12% (before Visit 1) to 28,1% (after Visit 3) in the overall cohort, from 21,6% to 47,4% in HF with reduced ejection fraction (HFrEF), from 11,5% to 28,2% in HFrEF with mildly reduced EF (HFmrEF), and from 4,5% to 12,7% in HFpEF. Target GDMT doses were used in a small proportion of patients. Sixty (1,2%) patients with HFrEF received drugs with proven efficacy from all four GDMT classes at target doses by study completion. Patients’ age and sex, body mass index, systolic blood pressure and heart rate, comorbidities, cardiac resynchronization therapy, previous hospitalization with HF, duration and functional class of HF, and EF value were associated with the prescription of GDMT classes and higher doses.

Conclusion. Contraindications to at least one GDMT class were identified in 9,7% of patients with HF. For patients without initial contraindications, an increase in quadruple therapy coverage was noted during the follow-up period, but titration and achievement of target doses were insufficient. Increasing awareness and overcoming therapeutic inertia of physicians are critically important for increasing the coverage of patients with HF with optimal therapy.

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