Implementation of Medical Therapy in Different Stages of Heart Failure with Reduced Ejection Fraction: An Analysis of the VIENNA-HF Registry

Background/Objectives. Real-world evidence shows alarmingly suboptimal utilization of GDMT in HFrEF. One of the barriers of GDMT implementation appears to be concerns about the potential development of drug-related ad-verse events (AEs), particularly in high-risk patients. This study aimed to evaluate whether advanced HfrEF (AHF) patients can be up-titrated safely and whether AHF predisposes to the occurrence of putatively drug-related AEs. Methods. A total of 373 HFrEF patients with documented baseline, 2 months and 12 months visits were analyzed for utilization and target dosages (TDs) of HF-drugs. Successful up-titration and AEs were evaluated for different stages of HF reflected by NT-proBNP (< 1000pg/ml, 1000-2000pg/ml, >2000pg/ml). Results. A stepwise increase in HF medications could be observed for all drug classes during follow-up. At 12 months 73%, 75%, 62%, 86% and 45% of pa-tients received ≥90% of TDs of beta-blockers (BB), renin-angiotensin system inhibitors (RASi), mineralocorticoid receptor antagonists (MRA), sodi-um-glucose cotransporter-2 inhibitors (SGLT2i), and triple-therapy, respec-tively. Predictors of successful up-titration in logistic regression were baseline HF-drug TDs, eGFR, and potassium, but not NT-proBNP or age. The devel-opment of AEs was rare, with hyperkalemia as the most common event (34% at 12 months). AEs were comparable in all stages of HF. However, develop-ment of hyperkalemia was more frequent in patients with higher NT-proBNP and also accounted for most cases for incomplete up-titration. Conclusion. This study suggests that with dedicated protocols and frequent visits GDMT can be successfully implemented across all stages of HFrEF, in-cluding patients with AHF.