Contemporary medical therapy for heart failure across the ejection fraction spectrum: The OPTIPHARM-HF registry

Aims: Despite guideline recommendations, guideline-directed medical therapy (GDMT) remains underused and underdosed in patients with heart failure (HF) across the ejection fraction (EF) spectrum. The aim of this study was to evaluate GDMT use, dosing, and implementation in a contemporary, nationwide HF cohort. Methods and results: The OPTIPHARM-HF (NCT06192524) is a prospective, multicentre, observational study enrolling adult patients with HF, across 32 Italian HF centres. Clinical characteristics, medical therapy prevalence and change after first visit have been assessed in patients with reduced (HFrEF: EF ≤40%), mildly reduced (HFmrEF: EF 40-49%), and preserved EF (HFpEF: EF ≥50%). From September 2022 to December 2024, 3054 patients (mean age 69 ± 12 years, 25% female) were enrolled: 56% with HFrEF, 21% with HFmrEF, and 23% with HFpEF. Among HFrEF, prescription frequencies were: 90% for beta-blockers; 19% for angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARB); 61% for angiotensin receptor-neprilysin inhibitors (ARNI); 72% for mineralocorticoid receptor antagonists (MRA); and 69% for sodium-glucose co-transporter 2 inhibitors (SGLT2i). Less than 60% achieved ≥50% of target doses. Quadruple therapy was received by 47% of the patients. After first visit, there was an increase in prescription of all classes of drugs, and titration to quadruple therapy was attained in 64% (p < 0.001). Among HFmrEF, 88% were on beta-blockers, 34% on ACEi/ARB, 49% on ARNI, 63% on MRA, and 59% on SGLT2i. In the HFpEF group, 76% were on beta-blockers, 49% on ACEi/ARB, 18% on ARNI, 49% on MRA and 40% on SGLT2i. After the first visit, SGLT2i prescription significantly increased both in HFmrEF (74%, p < 0.001) and HFpEF (54%, p < 0.001). Conclusions: Use of GDMT remains suboptimal across the EF spectrum although the adoption of quadruple GDMT in HFrEF and of SGLT2i in HFmrEF and HFpEF increased in recent years.