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

Abstract

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Rapid uptitration: what's the evidence?

“…Therefore, Fauvel et al 6 . investigated the opinion of cardiologists on sequencing, titration and optimal timing of all the recommended HFrEF drugs in their work published in this issue of the Journal.…”

“…Within this context, the survey by Fauvel et al . provide an important baseline assessment of contemporary cardiologists' thinking 6 . Their results show that most cardiologists and physicians still prefer the conventional uptitration sequence, which largely follows the chronology of clinical trials.…”

“…Moreover, as there is no randomized clinical trial performed to evaluate the effect of simultaneous initiation of low doses of quadruple therapy versus sequential use of the four classes of HF drugs in patients with HFrEF, clinical practice differs in the cardiology community (including cardiologists, HF specialists, and other physicians). 6 investigated the opinion of cardiologists on sequencing, titration and optimal timing of all the recommended HFrEF drugs in their work published in this issue of the Journal. The authors present results from a large international survey, with data collected among more than 600 practicing cardiologists from 55 countries.…”

“…[9][10][11] Within this context, the survey by Fauvel et al provide an important baseline assessment of contemporary cardiologists' thinking. 6 Their results show that most cardiologists and physicians still prefer the conventional uptitration sequence, which largely follows the chronology of clinical trials. However, most participants felt that rapid uptitration within 1 month was feasible, demonstrating physicians' openness to change.…”

February 2023 at a glance: focus on pathophysiology and treatment

“…Early start of the four pillars of guideline-directed medical therapies (GDMT) in patients with HF and reduced EF (HFrEF) is strongly suggested. 19,[21][22][23][24] A survey involving 615 cardiologists worldwide showed that the historical sequential approach (angiotensin-converting enzyme inhibitors or angiotensin receptor-neprilysin inhibitors first, beta-blockers second, mineralocorticoid receptor antagonists third, and sodium-glucose [22][23][24][25][26] A cost-effectiveness analysis showed that immediate versus 12-month delayed initiation of dapagliflozin is associated with almost 10% additional quality-adjusted life year gain and greater clinical benefits. 27 A consistent increase in haematocrit has been observed following the initiation of SGLT2i.…”