Educational professional activities for enhancing heart failure guidelines implementation: data from the Optimization of Therapy in the Italian Management of Heart Failure (OpTIMa-HF) Registry

Background: European guidelines recommend for heart failure with reduced ejection fraction (HFrEF) rapid initiation and later up-titration of four foundation drugs. We assessed whether an educational intervention might improve guideline-directed medical therapy (GDMT) use in Italian clinical practice. Methods: OpTIMa-HF is a multicenter observational registry including 29 Italian centers (hospital- and community-based HF outpatient clinics). The protocol included a retrospective phase (T0; January-October 2022), an educational intervention, and a prospective enrolment (T1; September-November 2023). HFrEF patients in retrospective and prospective phases were compared. Outcomes were prescription rates of GDMT drugs, combination therapy, management of contraindications, and drugs doses, adjusted for multiple comparisons using the Holm-Bonferroni procedure. Results: A total of 1,390 HFrEF patients were analyzed in T0 and 1,292 in T1. Patients enrolled in T1 were slightly older (70.5 vs 69.5 years; p=0.032), with similar sex distribution. After multiple comparisons, prescription rates increased for mineralocorticoid receptor antagonists (MRA, 75.8% vs 81.4%, p=0.040) and sodium-glucose co-transporter-2 inhibitors (SGLT2i, 63.2% to 80.3%, p<0.001), compared to T0. Quadruple therapy increased by approximately 30% (46.9% vs 61% p<0.001) and was stable after multiple comparisons, as the proportion of patients not receiving SGLT2i despite no contraindications that decreased from T0 to T1 (31.8% vs 17.1%; p<0.001). Conclusions: In patients with HFrEF educational activities are associated with improvement in guidelines recommended drugs implementation and might represent a feasible strategy to improve clinical practice.