13 Impact of rapid sequencing of heart failure therapy in patients recently hospitalised with heart failure with impaired left ventricular systolic function

<h3>Background</h3> Four ‘pillars’ of heart failure therapy have been shown to reduce morbidity and mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Although the European Society of Cardiology (ESC) guidelines recommend that all four therapies should be given in combination to all patients who can tolerate treatment, there is uncertainty on how rapidly treatment should be introduced and how well it is tolerated in real-world practice. Current conventional care models in the United Kingdom can take ≥6 months to combine all therapies. <h3>Aim</h3> To assess the rapid sequencing of HF therapies on left ventricular ejection fraction (LVEF) in patients newly diagnosed with HFrEF. <h3>Methods</h3> This was a single centre, prospective study of patients referred to the Heart Function Clinic, following a recent hospitalisation with a new diagnosis of HF. Patients attended 4 follow-up visits over an average of 12 weeks. All patients had transthoracic echocardiography at baseline and during follow-up. <h3>Results</h3> Sixty-four patients were included (mean age 69±14y, 31% females and 53% had ischemic cardiomyopathy aetiology). At the end of visit 4, 92% of all patients were established on beta-blockers, 94% on angiotensin converting-enzyme inhibitors or angiotensin receptor blockers or an angiotensin receptor-neprilysin inhibitor, 69% on mineralocorticoid receptor antagonists and 88% on sodium-glucose co-transporter 2 inhibitors, with 97% of all eligible patients on all four pillars of HF therapy. Compared to baseline, repeat echocardiography demonstrated significant improvement of LVEF (31.6±9.2 vs. 43.8±10.6, <i>P</i>&lt;0.001). At follow-up, more than half of the patients improved by at least one ESC HF classification class based on LVEF (24% improved by 1 and 27% of patients improved by 2). No patients had serious medication adverse events. <h3>Conclusion</h3> In a real-world setting, rapid sequencing of the four pillars of HF therapy was achievable, well tolerated and associated with significant improvement in LVEF.