AimsDespite clear guideline recommendations for initiating four drug classes in all patients with heart failure (HF) with reduced ejection fraction (HFrEF) and the availability of rapid titration schemes, information on real‐world implementation lags behind. Closely following the 2021 ESC HF guidelines and 2023 focused update, the TITRATE‐HF study started to prospectively investigate the use, sequencing, and titration of guideline‐directed medical therapy (GDMT) in HF patients, including the identification of implementation barriers.Methods and resultsTITRATE‐HF is an ongoing long‐term HF registry conducted in the Netherlands. Overall, 4288 patients from 48 hospitals were included. Among these patients, 1732 presented with de novo, 2240 with chronic, and 316 with worsening HF. The median age was 71 years (interquartile range [IQR] 63–78), 29% were female, and median ejection fraction was 35% (IQR 25–40). In total, 44% of chronic and worsening HFrEF patients were prescribed quadruple therapy. However, only 1% of HFrEF patients achieved target dose for all drug classes. In addition, quadruple therapy was more often prescribed to patients treated in a dedicated HF outpatient clinic as compared to a general cardiology outpatient clinic. In each GDMT drug class, 19% to 36% of non‐use in HFrEF patients was related to side‐effects, intolerances, or contraindications. In the de novo HF cohort, 49% of patients already used one or more GDMT drug classes for other indications than HF.ConclusionThis first analysis of the TITRATE‐HF study reports relatively high use of GDMT in a contemporary HF cohort, while still showing room for improvement regarding quadruple therapy. Importantly, the use and dose of GDMT were suboptimal, with the reasons often remaining unclear. This underscores the urgency for further optimization of GDMT and implementation strategies within HF management.

中文翻译：

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针对新发、慢性和恶化心力衰竭患者的当代指南指导药物治疗：TITRATE-HF 研究的第一个数据

目标尽管有明确的指南建议对所有射血分数降低的心力衰竭（HF）患者（HFrEF）启动四种药物类别并且有快速滴定方案的可用性，但有关实际实施的信息仍然滞后。紧随 2021 年 ESC 心力衰竭指南和 2023 年重点更新，TITRATE-HF 研究开始前瞻性调查心力衰竭患者指南指导药物治疗 (GDMT) 的使用、排序和滴定，包括识别实施障碍。方法和结果TITRATE-HF 是在荷兰进行的一项长期 HF 登记。总体而言，纳入了来自 48 家医院的 4288 名患者。在这些患者中，1732 名新发患者、2240 名慢性患者和 316 名恶化的心力衰竭患者。中位年龄为 71 岁（四分位距 [IQR] 63-78），29% 为女性，中位射血分数为 35%（IQR 25-40）。总共有 44% 的慢性和恶化的 HFrEF 患者接受了四联治疗。然而，只有 1% 的 HFrEF 患者达到了所有药物类别的目标剂量。此外，与普通心脏病门诊相比，在专门的心力衰竭门诊接受治疗的患者更常接受四联疗法。在每个 GDMT 药物类别中，19% 至 36% 的 HFrEF 患者未使用药物与副作用、不耐受或禁忌症有关。在从头心力衰竭队列中，49% 的患者已经使用一种或多种 GDMT 药物类别来治疗心力衰竭以外的其他适应症。结论 TITRATE-HF 研究的第一项分析报告了当代心力衰竭队列中 GDMT 的使用率相对较高，但仍存在空间关于四联疗法的改进。重要的是，GDMT 的使用和剂量并不理想，其原因通常尚不清楚。这凸显了进一步优化 GDMT 和 HF 管理实施策略的紧迫性。