TY - JOUR
T1 - Guideline implementation, drug sequencing, and quality of care in heart failure
T2 - design and rationale of TITRATE-HF
AU - Clephas, Pascal R.D.
AU - Malgie, Jishnu
AU - Schaap, Jeroen
AU - Koudstaal, Stefan
AU - Emans, Mireille
AU - Linssen, Gerard C.M.
AU - de Boer, Grytsje A.
AU - van Heerebeek, Loek
AU - Borleffs, C. Jan Willem
AU - Manintveld, Olivier C.
AU - van Empel, Vanessa
AU - van Wijk, Sandra
AU - van den Heuvel, Mieke
AU - da Fonseca, Carlos
AU - Damman, Kevin
AU - van Ramshorst, Jan
AU - van Kimmenade, Roland
AU - van de Ven, Arjen R.T.
AU - Tio, René A.
AU - van Veghel, Dennis
AU - Asselbergs, Folkert W.
AU - de Boer, Rudolf A.
AU - van der Meer, Peter
AU - Greene, Stephen J.
AU - Brunner-La Rocca, Hans Peter
AU - Brugts, Jasper J.
N1 - Publisher Copyright:
© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2024/2
Y1 - 2024/2
N2 - Aims: Current heart failure (HF) guidelines recommend to prescribe four drug classes in patients with HF with reduced ejection fraction (HFrEF). A clear challenge exists to adequately implement guideline-directed medical therapy (GDMT) regarding the sequencing of drugs and timely reaching target dose. It is largely unknown how the paradigm shift from a serial and sequential approach for drug therapy to early parallel application of the four drug classes will be executed in daily clinical practice, as well as the reason clinicians may not adhere to new guidelines. We present the design and rationale for the real-world TITRATE-HF study, which aims to assess sequencing strategies for GDMT initiation, dose titration patterns (order and speed), intolerance for GDMT, barriers for implementation, and long-term outcomes in patients with de novo, chronic, and worsening HF. Methods and results: A total of 4000 patients with HFrEF, HF with mildly reduced ejection fraction, and HF with improved ejection fraction will be enrolled in >40 Dutch centres with a follow-up of at least 3 years. Data collection will include demographics, physical examination and vital parameters, electrocardiogram, laboratory measurements, echocardiogram, medication, and quality of life. Detailed information on titration steps will be collected for the four GDMT drug classes. Information will include date, primary reason for change, and potential intolerances. The primary clinical endpoints are HF-related hospitalizations, HF-related urgent visits with a need for intravenous diuretics, all-cause mortality, and cardiovascular mortality. Conclusions: TITRATE-HF is a real-world multicentre longitudinal registry that will provide unique information on contemporary GDMT implementation, sequencing strategies (order and speed), and prognosis in de novo, worsening, and chronic HF patients.
AB - Aims: Current heart failure (HF) guidelines recommend to prescribe four drug classes in patients with HF with reduced ejection fraction (HFrEF). A clear challenge exists to adequately implement guideline-directed medical therapy (GDMT) regarding the sequencing of drugs and timely reaching target dose. It is largely unknown how the paradigm shift from a serial and sequential approach for drug therapy to early parallel application of the four drug classes will be executed in daily clinical practice, as well as the reason clinicians may not adhere to new guidelines. We present the design and rationale for the real-world TITRATE-HF study, which aims to assess sequencing strategies for GDMT initiation, dose titration patterns (order and speed), intolerance for GDMT, barriers for implementation, and long-term outcomes in patients with de novo, chronic, and worsening HF. Methods and results: A total of 4000 patients with HFrEF, HF with mildly reduced ejection fraction, and HF with improved ejection fraction will be enrolled in >40 Dutch centres with a follow-up of at least 3 years. Data collection will include demographics, physical examination and vital parameters, electrocardiogram, laboratory measurements, echocardiogram, medication, and quality of life. Detailed information on titration steps will be collected for the four GDMT drug classes. Information will include date, primary reason for change, and potential intolerances. The primary clinical endpoints are HF-related hospitalizations, HF-related urgent visits with a need for intravenous diuretics, all-cause mortality, and cardiovascular mortality. Conclusions: TITRATE-HF is a real-world multicentre longitudinal registry that will provide unique information on contemporary GDMT implementation, sequencing strategies (order and speed), and prognosis in de novo, worsening, and chronic HF patients.
UR - http://www.scopus.com/inward/record.url?scp=85179320900&partnerID=8YFLogxK
U2 - 10.1002/ehf2.14604
DO - 10.1002/ehf2.14604
M3 - Article
C2 - 38064176
AN - SCOPUS:85179320900
SN - 2055-5822
VL - 11
SP - 550
EP - 559
JO - ESC heart failure
JF - ESC heart failure
IS - 1
ER -