Optimization of the treatment of Heart Failure with Reduced Ejection Fraction following the updated European Society of Cardiology guidelines

Introduction

Heart failure (HF) is a prevalent global health issue Guideline-directed medical therapy (GDMT) has been pivotal in managing HF with reduced ejection fraction (HFrEF), emphasizing the use of four key drug classes.

Objective

Our main objective was to query the Moroccan cardiology community about the sequencing approach of heart failure medications and general compatibility with current guidelines.

Method

Our study is a large-sample survey study is based on questionnaire form previously used in an international survey on heart failure, published in 2022. The form was distributed via e-mail to Moroccan cardiologists. This questionnaire was translated into French to meet the specific requirements of our study and facilitate the collection of information.

Three predefined subgroup analyses were systematically performed: sex (male vs female), age (<30, 30–50, and >50 years), and practitioner type (residents in cardiology vs cardiology specialists).

Results

63 cardiologists practicing in northern Morocco responded to the survey. 65% of the participants considered LVEF ≤ 40% was the threshold to define HFrEF. The majority of participants (76.19%) would initiate HFrEF medical treatment with an ARNi instead of ACEi/ARB. 39.62% responded that adding another class of HFrEF medications is more important than increasing the dose of those already started. The “classic approach” of sequencing appears to be the most common, starting with ACEi or ARNi first (41%). Concerning the order of introduction of medications for heart failure, the “classic approach” appears to be the most common, starting with ACEi or ARNi first (41%), BB second (37%), and MRA third (45%) (Fig. 1). Nearly all participants believed it was feasible to initiate all four classes of heart failure medications during the first hospitalization. Beta-blockers were considered the most effective heart failure medication by 43% of participants followed by ARNIs (30%), but no practitioner aged > 50 considered that betablockers are the most effective medication. 65% of participants were hesitant to introduce mineralocorticoid receptor antagonists (MRA) when glomerular filtration rate (GFR) is < 30 ml/min.

Conclusion

Our results show that our practice needs more adherence to recent guidelines on the medical management of HFrEF, but young practitioners seem to join this journey compared to older generations, which would help advance in the management of our heart failure patients.