Exposure to Guideline-Recommended Quadruple Therapy after First Hospitalisation for HFrEF in France

Abstract Introduction In 2021, the European Society of Cardiology updated its guidelines for managing heart failure with reduced left ventricular ejection fraction (HFrEF), recommending a four-drug regimen combining an SGLT2 inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist, and a renin-angiotensin-aldosterone system inhibitor. This study assessed, six months after guideline publication, the exposure of this quadruple therapy in patients newly hospitalised for HFrEF and identified associated factors. Methods First-time hospitalisations for HFrEF in France in 2022 were identified using the French National Health Data System. Treatment exposure during the year following discharge was described. Logistic regression was used to assess factors associated with receiving quadruple therapy within 30 days, including socio-demographic characteristics, healthcare utilisation, and comorbidities. Results A total of 22,990 patients were included (65.1% men; mean age 74 years, SD 13.5). At 30 days, 26.3% of patients received quadruple therapy (22.5% at one year). Exposure rates were 76% for beta-blockers, 70% for renin-angiotensin-aldosterone system inhibitor, 58% for SGLT2 inhibitors, and 47% for mineralocorticoid receptor antagonists. Advanced age, female sex, and certain comorbidities were associated with a lower likelihood of receiving quadruple therapy, while early follow-up with a general practitioner or cardiologist increased this likelihood. Discussion Exposure of quadruple therapy remains limited, with challenges in both initiation and persistence over time. Older age and comorbidities would appear to constitute barriers. Further studies with longer follow-up after guideline publication are needed to assess temporal trends and the impact of strategies aimed at improving care.