Therapeutic inertia in the pharmacological management of heart failure with reduced ejection fraction.

The efficacy of patient empowerment has been emphasized recently by the EPIC-HF trial.40 Patient education can reinforce the partnership between health professionals and patients (i.e. patient-care partner approach). Randomized controlled trials (RCTs) have established the efficacy of several therapies to improve both symptoms and outcomes for patients with heart failure and reduced left ventricular ejection fraction (HFrEF). More recently, the OFICA Study,7 which included >1600 patients hospitalized with HF in 170 French centres on a single day, found that discharge medications were rarely at optimal dosage and remained largely unchanged following discharge.8 The result is that a large proportion of patients with HFrEF does not receive cardinal HF treatments or is prescribed suboptimal doses.9-11 Recently, the CHAMP-HF registry showed that only 1% of patients with HFrEF was treated, simultaneously, with target dose of ACE-I/ARB/ARNI, beta-blocker, and MRA.9 Reasons for not prescribing, or not up-titrating guideline-recommended medications might be many, but when audited, they are commonly not reported or clearly stated. They may furthermore operate through ambulatory IV diuretics infusion.34 Despite their usefulness, the use of HF clinics is suboptimal, possibly due to lack of capacity, geographical considerations, and funding issues.35 Ambulatory disease management programmes DMP, usually providing care outside of hospitals, have been shown to reduce the risk of both all-cause mortality and HF-related hospital readmission by approximately 30%36 and are now formally recommended in 2021 ESC guidelines on HF. [Extracted from the article]