"Baseline Characteristics and Utilization of Medical Therapies in Acute Hospitalized and Chronic Heart Failure Patients Enrolled in GRASP-HF: Differences Between ICARe-HF and Non-ICARe-HF Centres".
The Global Registries and Surveys Programme-Heart Failure (GRASP-HF) is a prospective, multicentre, international observational study assessing implementation of the 2021/2023 ESC-HF-Guidelines. GRASP-HF is aligned with the Improving Care through Accreditation and Recognition in Heart Failure (ICARe-HF) programme, which links centre-characteristics with guideline-implementation performance.
To compare baseline characteristics, guideline-directed-medical-therapy (GDMT) implementation, and in-hospital outcomes between GRASP-HF patients managed in centres participating or not participating in the ICARe-HF programme.
GRASP-HF patients were stratified by ICARe-HF participation, clinical settings, acute (AHF) vs chronic HF (CHF) and ejection fraction (EF) subtypes. Hierarchical multivariable logistic regression models evaluated associations with quadruple therapy implementation and in-hospital mortality.
Among 10,936 patients (63.3% CHF, 36.7% AHF), patients from ICARe-HF participating centres (51.3%) were older, more comorbid but with less severe congestion. In both CHF and AHF, ICARe-HF centres demonstrated greater GDMT utilization, particularly angiotensin receptor-neprilysin inhibitors and sodium-glucose-cotransporter-2 inhibitors. In HFrEF, quadruple therapy was more frequently implemented (47% vs 40% in CHF; 27% vs 24% at AHF discharge) and remained associated with ICARe-HF participation after adjustment, Odd Ratio (OR) =1.73, 95% Confidence Interval (CI) :1.17-2.55. Target doses remained suboptimal, particularly after AHF. Although crude in-hospital mortality was lower in ICARe-HF centres (2.3% vs 5.5%), this association was attenuated after multivariable adjustment (OR=0.87, 95% CI:0.48-1.56).
Participation in the ICARe-HF programme was associated with more comprehensive implementation of contemporary GDMT, particularly in HFrEF. The association with in-hospital mortality was attenuated after adjustment and should be considered exploratory.
To compare baseline characteristics, guideline-directed-medical-therapy (GDMT) implementation, and in-hospital outcomes between GRASP-HF patients managed in centres participating or not participating in the ICARe-HF programme.
GRASP-HF patients were stratified by ICARe-HF participation, clinical settings, acute (AHF) vs chronic HF (CHF) and ejection fraction (EF) subtypes. Hierarchical multivariable logistic regression models evaluated associations with quadruple therapy implementation and in-hospital mortality.
Among 10,936 patients (63.3% CHF, 36.7% AHF), patients from ICARe-HF participating centres (51.3%) were older, more comorbid but with less severe congestion. In both CHF and AHF, ICARe-HF centres demonstrated greater GDMT utilization, particularly angiotensin receptor-neprilysin inhibitors and sodium-glucose-cotransporter-2 inhibitors. In HFrEF, quadruple therapy was more frequently implemented (47% vs 40% in CHF; 27% vs 24% at AHF discharge) and remained associated with ICARe-HF participation after adjustment, Odd Ratio (OR) =1.73, 95% Confidence Interval (CI) :1.17-2.55. Target doses remained suboptimal, particularly after AHF. Although crude in-hospital mortality was lower in ICARe-HF centres (2.3% vs 5.5%), this association was attenuated after multivariable adjustment (OR=0.87, 95% CI:0.48-1.56).
Participation in the ICARe-HF programme was associated with more comprehensive implementation of contemporary GDMT, particularly in HFrEF. The association with in-hospital mortality was attenuated after adjustment and should be considered exploratory.
Authors
Chioncel Chioncel, Savarese Savarese, Laroche Laroche, Amir Amir, Tokmakova Tokmakova, Boutard Boutard, Cannata Cannata, Hayrapetyan Hayrapetyan, Sarnighausen Sarnighausen, El Ouafi El Ouafi, Soriano Soriano, Moura Moura, Lund Lund, Adamo Adamo, Guillouche Guillouche, Volterani Volterani, Iung Iung, Mullens Mullens, Metra Metra,
View on Pubmed