SIMULTANEOUS INTRODUCTION OF HEART FAILURE THERAPY DURING HOSPITALIZATION: RESULTS ON 12- MONTHS FOLLOW UP

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Background: Current heart failure (HF) Guidelines recommend the pre-discharge initiation and uptitration of four different classes of drugs for heart failure with reduced ejection fraction (HFrEF): beta blockers (BB), sodium-glucose cotransporter-2 inhibitors (SGLT2i), angiotensin converting enzyme inhibitors/angiotensin receptor/neprilysin inhibitor (ACEi/ARNI), and mineralocorticoid receptor antagonists (MRA).However, real world data regarding the recommended approach are lacking.We hypothesized that an early concomitantly administration and up-titration of four-pillars, compared with a conventional stepwise approach, may impact the vulnerable phase after hospitalization due to HF. Methods:This prospective, single center, observational study included consecutive in-hospital patients with HFrEF.After performing propensity score matching, they were divided according to treatment strategy into group 1 (G1), with predischarge start of all four-pillars, with their up-titration within 1 month at HF outpatient service, and group 2 (G2) with the stepwise four-pillars introduction.In our study group we preferred to firstly introduce SGLT2i and uptitrate BB, followed by ARNI or ACEi, if ARNI were not tolerated, and finally MRAs.The endpoints of the study were: HF hospitalizations, cardiovascular (CV) deaths, and their composite at 12 month follow up. Results:The study included a total of 192 patients who completed the 12-month follow-up (96 for both groups).There were no differences in terms of baseline features between the two groups.At survival analysis, HF hospitalization risk was significantly lower in G1 compared with G2 (p < 0.003), while no significant differences were observed regarding CV death (p = 0.07) and the composite of CV death and HF hospitalization (p = 1). Conclusion:In our real-world population, HFrEF patients treated with a predischarge, and simultaneous use of the four-pillars showed a reduced risk of HF hospitalization at 12 month follow up, compared with a conventional stepwise approach.No differences in term of CV death and composite of CV death and HF hospitalization have been demonstrated between the two groups.

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