(CCSP081) THE IMPACT OF FOUR PILLAR MEDICAL OPTIMIZATION ON CARDIAC BIOMARKERS AND STRUCTURAL PARAMETERS IN HEART FAILURE WITH REDUCED EJECTION FRACTION

Background: The STRONG-HF study demonstrated that aggressive up-titration of guideline directed medical therapy (GDMT) with Beta-blockers, Mineralocorticoid Receptor Inhibitors (MRA), Sacubitril-Valsartan (ARNI) and SGLT2 inhibitors (SGLT2i) in patients recently hospitalized for heart failure with reduced ejection fraction (HFrEF) leads to reduced HF hospitalization and mortality. Mechanistic explanations for the benefits seen in this study are necessary.

We sought to determine the impact of an aggressive HFrEF optimization program for achieving GDMT uptake on b-type natriuretic peptide (NT-proBNP) and echocardiographic parameters.

METHODS AND RESULTS: We conducted a single center study at a Canadian community cardiovascular centre using a prospective pre-post design. Patients with HFrEF with New York Heart Association (NYHA) class II/III referred from inpatient and outpatient settings were enrolled in a virtual 3-month HFrEF optimization program. All participants underwent an initial consult with a cardiologist. Patients were then seen remotely by a nurse every two weeks for up-titration of HFrEF medications with the goal of maximally tolerated GDMT within 3 months. Transthoracic echocardiograms and NT-proBNP were performed prior to participation in the program & after completion.

Over 9 months, 284 patients enrolled in the virtual HFrEF optimization program. At baseline, mean age was 67 and 70% were male, mean left ventricular ejection fraction (LVEF) was 34% and 54% had NYHA Class II symptoms. At baseline, the proportion of patients prescribed each class of GDMT was: 69% for Beta-blockers, 23% for MRA, 16% for ARNI and 7% for SGLT2i. At 3-month follow-up, rates of GDMT prescription were higher: 90% for beta-blockers (p < 0.01), 71% for MRA (p < 0.01), 95% for ARNI (p < 0.01) and 79% for SGLT2i (p < 0.01). From baseline to follow-up echocardiogram, mean LVEF increased from 34.4% to 49.8% (p < 0.01), mean Left Ventricular End Diastolic Diameter increased from 5.51 to 5.13 cm (p < 0.01). Mean Left Ventricular End Systolic Diameter improved from 4.33 to 3.75 cm (p < 0.01). Mean Left Ventricular Mass Index improved from 112.5 to 102.5 g/m2 (p < 0.01). From baseline to follow-up, mean serum NT-proBNP reduced from 1953 +/- 3398 to 674 +/- 859 pg/ml (p < 0.01). Mean serum creatinine and potassium also increased from 97.4 to 104.5 µmol/L (p < 0.01) and 4.48 to 4.58 (p < 0.01) respectively.

Conclusion: This study demonstrates that a community-based virtual program for HFrEF optimization can safely and rapidly promote uptake of GDMT and was associated with improvements in NT-proBNP and cardiac structural parameters.