MEDICAL TREATMENT IMPLEMENTATION IN AMBULATORY PATIENTS WITH HF: PRELIMINARY DATA FROM THE NATIONWIDE BRING–UP3 HF STUDY

Abstract Background Current ESC guidelines introduced a four–pillar approach for the treatment of HFrEF, and a Class IA recommendation for Empagliflozin and Dapagliflozin in HfmrEF and HFpEF. Objectives BRING–UP–3 Heart Failure (HF) study was designed to guide the guideline implementation recommendations in HF patients enrolled by a large sample of Italian cardiology sites. Methods BRING–UP–3 HF study is an observational, prospective, nationwide investigation encompassing 179 sites enrolling ambulatory and hospitalized HF patients. The study includes an educational intervention followed by two three–month enrollment periods and by a six–month follow–up period with end–point evaluation. For HFrEF patients, the objective is to describe the proportion of patients who receive the four pillars. Here we present the baseline data of the ambulatory cohort. Results A total of 3,830 ambulatory patients were included in the study. The mean age was 70±12 years (34.5% over 75 years), females were 21.9%. The most prevalent group was HFrEF (58.4%), followed by HFimpEF (17.4%), HFmrEF (14.4%), and HFpEF (9.8%). Hypertension, atrial fibrillation, diabetes mellitus, and chronic kidney disease were reported in 68.2%, 40.4%, 31.0%, and 33.1%, respectively. Figure 1 reports pre–post visit prescription rates of main HF medical treatments among different groups according to ejection fraction phenotypes. beta–blockers and RASi (with ARNIs widely preferred over ACE–I/ARNIs ) were prescribed in over 90% while SGLT2i and MRAs were prescribed in over 80% of cases. Consequently, among HFrEF patients, a high prescription rate of combination treatments could be observed (Figure 2) with 65% of patients being prescribed the four therapeutic pillars. In HFmrEF and HFpEF, SGLT2i prescription rates reached 72.1% and 50.1%, respectively. Conclusions A comprehensive analysis of a large sample of Italian cardiology sites revealed a high prevalence of prescription of guideline–recommended treatments.