Contemporary Implementation of Guideline-Directed Medical and Device Therapies in Heart Failure: Insights from the Central/Eastern Europe Quality of Care Centres Survey
Year: 2025
Type: article
Study design: Observational Study
Abstract: AIMS: The Central/Eastern Europe (CEE) Quality of Care Centres (QCC) Survey evaluated the implementation of guideline-directed medical therapies (GDMT) and device use at discharge after heart failure (HF) hospitalization in CEE, where GDMT underutilization remains a concern. METHODS AND RESULTS: Between March 2024 and January 2025, 2251 patients (mean age 70.0 years, 60.4% male) were enrolled at discharge from 21 centres across 12 CEE countries. The patient population included HF with reduced ejection fraction (HFrEF) (55.5%), HF with mildly reduced ejection fraction (15.3%) and HF with preserved ejection fraction (27.9%). In the total population, from admission to discharge there was a increase in the use of angiotensin receptor-neprilysin inhibitor (ARNI) (17.1% to 34.3%), beta-blockers (69.4% to 92.4%), mineralocorticoid receptor antagonists (MRA) (44.0% to 82.1%) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) (30.8% to 79.9%), with a reduction in angiotensin-converting enzyme inhibitor (ACEI) use (all p < 0.05). Similar trends were observed across HF phenotypes, including HFrEF (increased use of ARNI, 26.3% to 55.1%, beta-blockers, 69.8% to 95.3%, MRA 49.5% to 89.0%, and SGLT2I 36.2% to 79.8%, and lower ACEI use, all p < 0.05). At discharge, 53.5% of patients received quadruple therapy (63.9% with HFrEF), while ≥50% target doses of titratable drugs were achieved in 18.8% (17.8% in HFrEF). Predictors of GDMT underuse included older age, lower education, living alone, non-ischaemic HF, higher ejection fraction, chronic kidney disease, hypotension, hyperkalaemia, prolonged hospitalization, and residual oedema. Among eligible HFrEF patients, 21.3% were discharged with, or referred for implantable cardioverter-defibrillator, and 17.4% for cardiac resynchronization therapy. CONCLUSIONS: The CEE-QCC Survey highlights substantial in-hospital GDMT implementation and up-titration, though device use remains limited. Targeted strategies are needed to enhance guideline implementation and ensure optimal HF care across the CEE region.
DOI: 10.1002/ejhf.70031
Authors: Petar M. Seferović, Marija Polovina, Jan Krejči, Bela Merkely, Mariya Tokmakova, Martin Huelssmann, Vladimir Miloradović, Svetlana Apostolović, Elizabeta Srbinovska-Kostovska, Slavica Radovanović, Anastazija Stojšić-Milosavljević, Aleksandra Milovančev, Marija Zdravković, Duška Glavaš, Tamara Preradović-Kovačević, Eva Goncalvesova, Michal Laufer-Perl, Nataša Marković-Nikolić, Zumreta Kušljugić, Larisa Hudić-Dizdarević, Dan Gaita, Ginta Kamzola, Robert Sepp, Dragan Simić, Arsen Ristić, Milika Ašanin, Gordana Krljanac, Petar Otašević, Dejana Stanisavljević, Davor Miličić, Magdy Abdelhamid, Gianluigi Savarese, Central/Eastern Europe QCC Survey Young Investigators
Institutions: Serbian Academy of Sciences and Arts, University of Belgrade, Univerzitetski Klinički Centar Srbije, St. Anne's University Hospital Brno, Semmelweis University, Medical University Plovdiv, Medical University of Vienna, University of Kragujevac, Clinical Centre of Kragujevac, University of Nis, Klinički centar Niš, University Hospital Center Dr Dragiša Mišović, University of Novi Sad, Institute for Cardiovascular Diseases of Vojvodina, University Hospital Medical Center Bezanijska kosa, Klinički Bolnički Centar Split, University of Split, University of Banja Luka, University clinical center of Republika Srpska, National Institute of Cardiovascular Diseases, Tel Aviv Sourasky Medical Center, Kliničko Bolnički Centar Zvezdara, University of Tuzla, University Clinical Center Tuzla, Pauls Stradiņš Clinical University Hospital, University of Szeged, Institut za kardiovaskularne bolesti Dedinje, University Hospital Centre Zagreb, University of Zagreb, Cairo University, Karolinska University Hospital, Karolinska Institutet
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Boehringer Ingelheim España
OpenAlex ID: W4414533438