Differences in heart failure with preserved ejection fraction management between care providers: an international survey

Federica Guidetti; Clara Inés Saldarriaga Giraldo; Anastasia Shchendrygina; Keisuke Kida; David Niederseer; Carmen Basic; Peter P Rainer; Marta Załęska-Kocięcka; Elijah Ogola; Dania Mohty; Giuseppina Lanfranchi; Novi Yanti Sari; Hafsteinn Einarsson; Marzena Zurek; Frank Ruschitzka; Gianluigi Savarese; Nathan Mewton

doi:10.1002/ejhf.3416

Differences in heart failure with preserved ejection fraction management between care providers: an international survey

Eur J Heart Fail. 2024 Aug 21. doi: 10.1002/ejhf.3416. Online ahead of print.

Authors

Federica Guidetti¹, Clara Inés Saldarriaga Giraldo², Anastasia Shchendrygina³, Keisuke Kida⁴, David Niederseer^{5

6

7}, Carmen Basic^{8

9}, Peter P Rainer^{10

11

12}, Marta Załęska-Kocięcka¹³, Elijah Ogola¹⁴, Dania Mohty^{15

16}, Giuseppina Lanfranchi¹⁷, Novi Yanti Sari¹⁸, Hafsteinn Einarsson¹⁹, Marzena Zurek²⁰, Frank Ruschitzka^{7

20}, Gianluigi Savarese^{1

21}, Nathan Mewton²²

Affiliations

¹ Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
² Pontificia Bolivariana, University of Antioquia, Cardiovid Clinic, Medellin, Colombia.
³ IM Sechenov First Moscow State Medical University, Moscow, Russia.
⁴ Department of Pharmacology, St Marianna University School of Medicine, Kawasaki, Japan.
⁵ Hochgebirgsklinik Davos, Medicine Campus Davos, Davos, Switzerland.
⁶ Christine Kuhne Center for Allergy Research and Education (CK-CARE), Medicine Campus Davos, Davos, Switzerland.
⁷ Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁸ Department of Medicine Geriatrics and Emergency Medicine/stra, Region Vstra Gtaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁹ Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
¹⁰ Department of Cardiology, Medical University of Graz, Graz, Austria.
¹¹ BioTechMed Graz, Graz, Austria.
¹² St. Johann in Tirol General Hospital, St. Johann in Tirol, Austria.
¹³ Department of Heart Failure and Transplantology, Department of Mechanical Circulatory Support and Transplantation, National Institute of Cardiology, Warsaw, Poland.
¹⁴ Department of Clinical Medicine and Therapeutics, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya.
¹⁵ Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
¹⁶ College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
¹⁷ Geriatric Departement, Hôpital Pierre Garraud, Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France.
¹⁸ Department of Cardiology, Dr. Muhammad Hoesin General Hospital, Palembang, Indonesia.
¹⁹ Department of Computer Science, University of Iceland, Reykjavík, Iceland.
²⁰ Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Zürich, Switzerland.
²¹ Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.
²² Hôpital Cardiovasculaire Louis Pradel Hospices Civils de Lyon, Heart Failure Department Clinical Investigation Center Inserm 1407 CarMeN Inserm 1060, University Claude Bernard Lyon, Bron, France.

PMID: 39169613
DOI: 10.1002/ejhf.3416

Abstract

Aims: Heart failure (HF) with preserved ejection fraction (HFpEF) is characterized by growing incidence and poor outcomes. A large majority of HFpEF patients are cared by non-cardiologists. The availability of sodium-glucose cotransporter 2 inhibitors (SGLT2i) as recommended therapy raises the importance of prompt and accurate identification and treatment of HFpEF across diverse healthcare settings. We evaluated HFpEF management across specialties through a survey targeting cardiologists, HF specialists, and non-cardiologists.

Methods and results: An independent web-based survey was distributed globally between May and July 2023. We performed a post-hoc analysis, comparing cardiologists, HF specialists, and non-cardiologists. A total of 1460 physicians (61% male, median age 41[34-49]) from 95 countries completed the survey; 20% were HF specialists, 65% cardiologists, and 15% non-cardiologists. Compared with HF specialists, non-cardiologists and cardiologists were less likely to use natriuretic peptides (p = 0.003) and HFpEF scores (p = 0.004) for diagnosis, and were also less likely to have access to or consider specific echocardiographic parameters (p < 0.001) for identifying HFpEF. Diastolic stress tests were used in less than 30% of the cases, regardless of the specialty (p = 1.12). Multidrug treatment strategies were similar across different specialties. While SGLT2i and diuretics were the preferred drugs, angiotensin receptor blockers and angiotensin receptor-neprilysin inhibitors were the least frequently prescribed in all three groups. However, when constrained to choose one drug, the proportion of physicians favoring SGLT2i varied significantly among specialties (66% HF specialists, 52% cardiologists, 51% non-cardiologists). Additionally, 10% of non-cardiologists and 8% of cardiologists considered beta blocker the drug of choice for HFpEF.

Conclusion: Significant differences among specialty groups were observed in HFpEF management, particularly in the diagnostic work-up. Our results highlight a substantial risk of underdiagnosis and undertreatment of HFpEF patients, especially among non-HF specialists.

Keywords: Heart failure; Heart failure with preserved ejection fraction; Management improvement; SGLT2 inhibitors; Survey.