Guideline-directed medical therapy at discharge: an explorative heart failure phenotype substudy of the randomized controlled HANSE-STEPS trial

Heart failure (HF) is associated with increased mortality, morbidity and less quality of life. Reasons are various, such as missing guideline-directed medical therapy (GDMT) at discharge. This data is lacking for Germany.

Methods

A single center randomized controlled trial – HANSE-STEPS – compared two arms of HF non-invasive surveillance. One group was quarterly asked in a standardized phone call by HF nurses, the other one telemonitored by step trackers and daily data transfer on a telemedical platform. The primary endpoint was unplanned phone calls or HF visits by the patients. Secondary endpoints were cardiovascular death, HF rehospitalization, quality of life by EQ5D and KCCQ, 6-minute walking distance and fulfillment of GDMT.

Results

From 2022 to 2024 a total of 200 patients were recruited and randomized at 1:1. Total age is 63.9±15.2 years. At baseline HF with reduced ejection fraction (HFrEF) was present in 69,5% (n=139) patients, HF with improved ejection fraction (HFimpEF) in 13% (n=26), HF with mildy reduced ejection fraction (HFmrEF) in 5% (n=10) and HF with preserved ejection fraction (HFpEF) in 12,5% (n=25). GDMT is reported at baseline for all HF phenotypes:

In HFrEF angiotensin converting enzyme inhibitor 3.6% (ACEi, n=5), angiotensin receptor blocker 4.3% (ARB, n=6), sacubitril/valsartan 91.4% (ARNI, n=127), betablocker 96.4% (BB, n=134), mineralocorticoid antagonist 89.2% (MRA, n=124), sodium glucose linked cotransporter 2-inhibitor 95.0% (SGLT2i, n=132), vericiguat 13.7% (n=19), oral loop diuretics 66.9% (n=93) ivabradine 1.4% (n=2), amiodaron 16.5% (n=23), digoxin 2.2% (n=3); in HFimpEF ACEi 3.8% (n=1), ARNI 96.2 (n=25), BB 88.5% (n=23), MRA 88.5% (n=23), SGLT2i 100% (n=26), oral loop diuretics 50% (n=13), ivabradine 3.8% (n=1), amiodaron 19.2% (n=5), digoxin 3.8% (n=1); in HFmrEF ACEi 60% (n=6), ARB 40% (n=4), BB 90% (n=9), MRA 50% (n=5), SGLT2i 70% (n=7) and oral loop diuretics 70% (n=7) as well as in HFpEF ACEi 32% (n=8), ARB 40% (n=10), BB 88% (n=22), MRA 40% (n=10), SGLT2i 92% (n=23), oral loop diuretics 84% (n=21), amiodaron 20% (n=5) and digoxin 12% (n=3). Therefore, four pillar GDMT reached 89.2% in HFrEF and 88.5% in HFimpEF at discharge.

Gender proportions were 34 women and 105 men in HFrEF, 12 women and 14 men in HFimpEF, 3 women and 7 men in HFmrEF and 9 women and 16 men in HFpEF.

Conclusion

These are the highest GDMT rates reported at discharge in Germany, especially for HFrEF and HFimpEF. Further gender analyses are conducted regarding phenotypes and dosing differences.