Authors

• Domagoj Marković — University Hospital Center Split, Split, Croatia — ORCID: 0000-0002-9432-6882
• Jelena Stipanović — Family Medicine Clinic, Split, Croatia
• Ingrid Prkačin — University Hospital “Merkur”, Zagreb, Croatia — ORCID: 0000-0002-5830-7131
• Antonela Karačić — University Hospital Center Split, Split, Croatia
• Duška Glavaš — University Hospital Center Split, Split, Croatia — ORCID: 0000-0003-2649-0936

Keywords

heart failure, guidelines, beta blockers, diuretics, sodium-glucose transporter 2 inhibitors

DOI

Full Text

**Introduction:** The treatment approach for heart failure patients, according to recent European Society of Cardiology (ESC) guidelines and scientific papers, is well defined (1). The aim of this study was to investigate whether the prescribed therapy for the treatment of heart failure in patients from Split region, follows the latest ESC guidelines. **Patients and Methods:** The study analyzed patients with heart failure included in CRO-HF registry, Split region, who were hospitalized in the period between 2022 and 2023. There were 37 patients (32%) in the heart failure group with preserved ejection fraction (HFpEF), 18 (16%) had mildly reduced ejection fraction (HFmrEF) and 60 (52%) had reduced ejection fraction (HFrEF). Fisher’s test was used to compare variables, and statistical significance was set at p <0.05. **Results:** Overall, 106 (92%) patients with heart failure were prescribed diuretics and 102 (89%) beta blocker therapy. Less often patients had mineralocorticoid receptor antagonist (MRA) medication 77 (67%), sodium glucose cotransporter 2 (SGLT2) inhibitors 74 (64%) and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blockers (ARB)/angiotensin receptor/neprilysin inhibitor (ARNI) 72 (63%). There was no difference in diuretic therapy between groups (p=0.067). According to ESC guidelines, beta blockers were prescribed in 95% patients with HFrEF and HFmrEF, and in 76% patients with HFpEF (p=0.018). MRA and ACEi/ARB/ARNI were prescribed in 12 (67%) patients with HFmrEF; MRA in 48 (80%) and ACEi/ARB/ARNI in 47 (78%) patients with HFrEF (p=0.003 and p<0.001; respectively). SGLT2 inhibitors were prescribed in only 10 (27%) patients with HFpEF and in 47 (78%) patients with HFrEF (p<0.001). **Conclusion:** In Split region, diuretic and beta blocker therapy was prescribed in all heart failure groups according to ESC guidelines. MRA and ACEi/ARB/ARNI were prescribed less often compared to the recommendations from the guidelines in HFrEF and HFmrEF patients, while SGLT2 inhibitors were underprescribed in all heart failure groups. The study discusses current heart failure therapy in patients from Split region and we need future complex initiatives and trials to give new information and explanation of these results.

Literature

1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 September;42(36):3599–726. https://doi.org/10.1093/eurheartj/ehab368