Optimisation of heart failure management: insights into GDMT and loop diuretic utilisation in a specialised heart failure clinic

Abstract Background and aims Loop diuretic maintenance therapy has been associated with worse clinical outcomes in heart failure (HF) patients. Despite this, recent HF trials report high prescription rates. Optimal guideline-directed medical therapy (GDMT) may reduce need for loop diuretics and improve long-term outcomes. This study evaluated loop diuretic and GDMT prescription patterns in a HF clinic of a Belgian tertiary hospital cohort and compared findings to recent HF trials. Methods This prospective registry included consecutive HF patients with a left ventricular ejection fraction (LVEF) ≤50% from the HF outpatient clinic starting from 23 November 2023 to 22 May 2024 up to the inclusion of 1000 patients. Data on baseline characteristics, medications, echocardiography and laboratory were extracted from electronical health records. Results Among the included patients, 543 (54.3%) had HF with reduced ejection fraction. Median age was 72 (63–80) years, with a median LVEF of 45% (35–45). Most were male (72.6%), with serum creatinine of 1.15 (0.93–1.45) mg/dL and eGFR of 60 (43–77) mL/min/1.73 m2. Hypertension (56%), atrial fibrillation (47%), and coronary revascularisation (53%) were common comorbidities. GDMT prescription rates were high, with 68.7% on triple or quadruple therapy, while only 27% received loop diuretics. Baseline characteristics and GDMT prescription rates were comparable to recent registries and trials, but loop diuretic prescriptions were significantly lower in the current cohort. Conclusions This study highlights progress in HF management but emphasises the need for a patient-centred approach in a HF clinic which enables optimisation of care, allows addressing comorbidities, and reduction in loop diuretic dependence.