Abstract 17378: A Novel Strategy in the Sequencing of HFrEF Therapy: An Upfront and Prompt Approach

Abstract

Introduction: The latest HF European guidelines recommend the use of four different classes of drugs for HFrEF. Despite advances in treatment, some gaps remain to be filled. In particular, sequencing and timing of HF therapy administration are not clarified and different strategies have been proposed. Hypothesis: An early, upfront novel approach, based on prompt administration of BB, SGLT2i, ACEi/ARNI, and MRAs may prove beneficial in terms of HF rehospitalization and CV death risk reduction. Aims: To compare early sequencing of HFrEF GDMT with the conventional, stepwise strategy. The primary endpoint was a composite of HF rehospitalization and CV death. Secondary endpoints were the single events of the primary endpoint. Methods: This prospective, observational study included consecutive patients with a HFrEF diagnosis from the Cardiology department. They were divided based on treatment strategy. Group 1 (G1) was treated with a novel GDMT sequencing (in-hospital start of BB and SGLT2i, ACE-i/ARNI, and lastly adding MRAs within 30 days from discharge). Group 2 (G2) was treated with the conventional, stepwise GDMT sequencing. Comparison between the two groups has been performed at 6-month follow up. Results: The study included a total of 302 patients. 278 patients underwent follow up: 139 in G1 group and 139 in G2 group. The two groups did not show significant differences at baseline. No significant differences have been observed for the primary composite outcome (p= 0.135) and for CV mortality (p=0.642) between the two groups. HF rehospitalization risk was significantly lower in G1 group compared to G2 group (p<0.001). Conclusions: HFrEF patients treated with a novel GDMT sequencing, promptly initiated and completed within 30 days from discharge, have shown reduced risk of HF rehospitalization compared with the conventional strategy.