Применение рекомендованной болезнь-модифицирующей терапии у амбулаторных пациентов с хронической сердечной недостаточностью в реальной клинической практике: субанализ исследования ПРИОРИТЕТ-ХСН

Use of guideline-directed medical therapy in outpatients with heart failure in real-world practice: a subanalysis of PRIORITY-HF study

Aim. To describe the contraindication rate and the prescription and titration features of guideline-directed medical therapy (GDMT) in outpatients with heart failure (HF). Material and methods. This retrospective analysis of contraindication rate to four GDMT classes was performed in 19981 outpatients with HF included in the PRIORITY HF study. The changes of drug prescription and titration were assessed in a cohort of patients without contraindications and who underwent visits at 6 and 12 months of follow-up. The multivariate mixed logistic regression was used to determine fac tors associated with the prescription and higher doses of GDMT drugs. Results. A total of 1943 (9,7%) study participants had baseline contraindications to at least one GDMT class. Among the 15575 patients without contraindications who completed all study visits, quadruple therapy coverage increased from 12% (be fore Visit 1) to 28,1% (after Visit 3) in the overall cohort, from 21,6% to 47,4% in HF with reduced ejection fraction (HFrEF), from 11,5% to 28,2% in HFrEF with mild ly reduced EF (HFmrEF), and from 4,5% to 12,7% in HFpEF. Target GDMT doses were used in a small proportion of patients. Sixty (1,2%) patients with HFrEF re ceived drugs with proven efficacy from all four GDMT classes at target doses by study completion. Patients’ age and sex, body mass index, systolic blood pres sure and heart rate, comorbidities, cardiac resynchronization therapy, previous hos pitalization with HF, duration and functional class of HF, and EF value were associ ated with the prescription of GDMT classes and higher doses. Conclusion. Contraindications to at least one GDMT class were identified in 9,7% of patients with HF. For patients without initial contraindications, an increase in quadruple therapy coverage was noted during the follow-up period, but titration and achievement of target doses were insufficient. Increasing awareness and over coming therapeutic inertia of physicians are critically important for increasing the coverage of patients with HF with optimal therapy. © 2025, Silicea-Poligraf. All rights reserved.