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Seferović PM, Polovina M, Adlbrecht C, et al. Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical therapy in heart failure with reduced ejection fraction. Eur J Heart Fail. 2021;doi: 10.1002/ejhf.2378.
Seferović, P. M., Polovina, M., Adlbrecht, C., Bělohlávek, J., Chioncel, O., Goncalvesová, E., Milinković, I., Grupper, A., Halmosi, R., Kamzola, G., Koskinas, K. C., Lopatin, Y., Parkhomenko, A., Põder, P., Ristić, A. D., Šakalytė, G., Trbušić, M., Tundybayeva, M., Vrtovec, B., Yotov, Y. T., Miličić, D., Ponikowski, P., Metra, M., Rosano, G., & Coats, A. J. S. (2021). Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical therapy in heart failure with reduced ejection fraction. European journal of heart failure, . https://doi.org/10.1002/ejhf.2378
Seferović, Petar M, et al. "Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical therapy in heart failure with reduced ejection fraction." European journal of heart failure vol. (2021). doi: https://doi.org/10.1002/ejhf.2378
Seferović PM, Polovina M, Adlbrecht C, Bělohlávek J, Chioncel O, Goncalvesová E, Milinković I, Grupper A, Halmosi R, Kamzola G, Koskinas KC, Lopatin Y, Parkhomenko A, Põder P, Ristić AD, Šakalytė G, Trbušić M, Tundybayeva M, Vrtovec B, Yotov YT, Miličić D, Ponikowski P, Metra M, Rosano G, Coats AJS. Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical therapy in heart failure with reduced ejection fraction. Eur J Heart Fail. 2021 Nov 09; doi: 10.1002/ejhf.2378. Epub 2021 Nov 09. PMID: 34755422.
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Eur J Heart Fail. 2021 Nov 09; doi: 10.1002/ejhf.2378. Epub 2021 Nov 09.

Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical therapy in heart failure with reduced ejection fraction.

European journal of heart failure

Petar M Seferović, Marija Polovina, Christopher Adlbrecht, Jan Bělohlávek, Ovidiu Chioncel, Eva Goncalvesová, Ivan Milinković, Avishay Grupper, Róbert Halmosi, Ginta Kamzola, Konstantinos C Koskinas, Yuri Lopatin, Alexander Parkhomenko, Pentti Põder, Arsen D Ristić, Gintarė Šakalytė, Matias Trbušić, Meiramgul Tundybayeva, Bojan Vrtovec, Yoto T Yotov, Davor Miličić, Piotr Ponikowski, Marco Metra, Giuseppe Rosano, Andrew J S Coats

Affiliations

  1. Faculty of Medicine, Belgrade University, Belgrade, Serbia.
  2. Serbian Academy of Sciences and Arts, Belgrade, Serbia.
  3. Department of Cardiology, University Clinical Centre, Belgrade, Serbia.
  4. Imed19-privat, Private Clinical Research Center, Vienna, Austria.
  5. Second Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
  6. University of Medicine Carol Davila, Bucharest, Romania.
  7. Emergency Institute for Cardiovascular Diseases "Prof. C.C. Iliescu", Bucharest, Romania.
  8. Department of Cardiology, Faculty of Medicine Comenius University and National Cardiovascular Institute, Bratislava, Slovakia.
  9. Cardiology Division, Sheba Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
  10. First Department of Medicine, University of Pecs, Medical School, Pecs, Hungary.
  11. Kamzola: Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia.
  12. Department of Cardiology, Bern University Hospital, Bern, Switzerland.
  13. Regional Cardiology Centre Volgograd, Volgograd State Medical University, Volgograd, Russian Federation.
  14. Emergency Cardiology Department, Institute of Cardiology, Kyiv, Ukraine.
  15. First Cardiology Department, North Estonia Medical Centre Foundation, Tallinn, Estonia.
  16. Department of Cardiology, Medical Academy, Faculty of Medicine Lithuanian University of Health Sciences, Kaunas, Lithuania.
  17. School of Medicine, University of Zagreb, Zagreb, Croatia.
  18. Department of Cardiology, Kazakh National Medical University, Almaty, Kazakhstan.
  19. Department of Cardiology, UMC, Ljubljana, Slovenia.
  20. First Department of Internal Medicine, Medical University of Varna, Varna, Bulgaria.
  21. Second Cardiology Clinic, University Hospital St. Marina, Varna, Bulgaria.
  22. Centre for Heart Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.
  23. Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
  24. RCCS San Raffaele Pisana, Rome, Italy.
  25. University of Warwick, Coventry, UK.

PMID: 34755422 DOI: 10.1002/ejhf.2378

Abstract

Guideline-directed medical therapy (GDMT) has the potential to reduce the risks of mortality and hospitalisation in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data indicate that many patients with HFrEF do not receive optimised GDMT, which involves several different medications, many of which require up-titration to target doses. There are many challenges to implementing GDMT, the most important being patient-related factors (comorbidities, advanced age, frailty, cognitive impairment, poor adherence, low socioeconomic status), treatment-related factors (intolerance, side-effects) and healthcare-related factors that influence availability and accessibility of HF care. Accordingly, international disparities in resources for HF management and limited public reimbursement of GDMT, coupled with clinical inertia for treatment intensification combine to hinder efforts to provide GDMT. In this review paper, authors aim to provide solutions based on available evidence, practical experience, and expert consensus on how to utilise evolving strategies, novel medications, and patient profiling to allow the more comprehensive uptake of GDMT. Authors discuss professional education, motivation, and training, as well as patient empowerment for self-care as important tools to overcome clinical inertia and boost GDMT implementation. We provide evidence on how multidisciplinary care and institutional accreditation can be successfully used to increase prescription rates and adherence to GDMT. We consider the role of modern technologies in advancing professional and patient education and facilitating patient-provider communication. Finally, authors emphasise the role of novel drugs (especially sodium-glucose co-transporter 2 inhibitors), and a tailored approach to drug management as evolving strategies for the more successful implementation of GDMT.

© 2021 European Society of Cardiology.

Keywords: Guideline-directed medical therapy; Health education; Heart failure; Medication adherence; Optimal treatment; Quality of care; Sodium-glucose co-transporter 2 inhibitors

References

  1. Seferovic PM, Vardas P, Jankowska EA, Maggioni AP, Timmis A, Milinkovic I, et al. The Heart Failure Association atlas: heart failure epidemiology and management statistics 2019. Eur J Heart Fail. 2021;23(6):906-14. - PubMed
  2. 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;42(36):3599-726. - PubMed
  3. Komajda M, Schöpe J, Wagenpfeil S, Tavazzi L, Böhm M, Ponikowski P, et al.; QUALIFY Investigators. Physicians' guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry. Eur J Heart Fail. 2019;21(7):921-9. - PubMed
  4. Ouwerkerk W, Voors AA, Anker SD, Cleland JG, Dickstein K, Filippatos G, et al. Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study. Eur Heart J. 2017;38(24):1883-90. - PubMed
  5. Greene SJ, Fonarow GC, DeVore AD, Sharma PP, Vaduganathan M, Albert NM, et al. Titration of medical therapy for heart failure with reduced ejection fraction. J Am Coll Cardiol. 2019;73(19):2365-83. - PubMed
  6. Komajda M, Böhm M, Borer JS, Ford I, Tavazzi L, Pannaux M, et al. Incremental benefit of drug therapies for chronic heart failure with reduced ejection fraction: a network meta-analysis. Eur J Heart Fail. 2018;20(9):1315-22. - PubMed
  7. Laribi S, Aouba A, Nikolaou M, Lassus J, Cohen-Solal A, Plaisance P, et al.; GREAT Network. Trends in death attributed to heart failure over the past two decades in Europe. Eur J Heart Fail. 2012;14(3):234-9. - PubMed
  8. Kimmoun A, Takagi K, Gall E, Ishihara S, Hammoum P, El Bèze N, et al. Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta-regression in the past four decades. Eur J Heart Fail. 2021;23(3):420-31. - PubMed
  9. McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al.; DAPA-HF Trial Committees and Investigators. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381(21):1995-2008. - PubMed
  10. Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, et al.; EMPEROR-Reduced Trial Investigators. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020;383(15):1413-24. - PubMed
  11. Seferović PM, Fragasso G, Petrie M, Mullens W, Ferrari R, Thum T, et al. Heart Failure Association of the European Society of Cardiology update on sodium-glucose co-transporter 2 inhibitors in heart failure. Eur J Heart Fail. 2020;22(11):1984-6. - PubMed
  12. Seferović PM, Fragasso G, Petrie M, Mullens W, Ferrari R, Thum T, et al. Sodium-glucose co-transporter 2 inhibitors in heart failure: beyond glycaemic control. A position paper of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020;22(9):1495-503. - PubMed
  13. Maddox TM, Januzzi JL Jr, Allen LA, Breathett K, Butler J, Davis LL, et al. 2021 Update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021;77(6):772-810. - PubMed
  14. Gayat E, Arrigo M, Littnerova S, Sato N, Parenica J, Ishihara S, et al.; GREAT Network. Heart failure oral therapies at discharge are associated with better outcome in acute heart failure: a propensity-score matched study. Eur J Heart Fail. 2018;20(2):345-54. - PubMed
  15. Wirtz HS, Sheer R, Honarpour N, Casebeer AW, Simmons JD, Kurtz CE, et al. Real-world analysis of guideline-based therapy after hospitalization for heart failure. J Am Heart Assoc. 2020;9(16):e015042. - PubMed
  16. Fonarow GC, Albert NM, Curtis AB, Gheorghiade M, Liu Y, Mehra MR, et al. Incremental reduction in risk of death associated with use of guideline-recommended therapies in patients with heart failure: a nested case-control analysis of IMPROVE HF. J Am Heart Assoc. 2012;1(1):16-26. - PubMed
  17. Zaman S, Zaman SS, Scholtes T, Shun-Shin MJ, Plymen CM, Francis DP, et al. The mortality risk of deferring optimal medical therapy in heart failure: a systematic comparison against norms for surgical consent and patient information leaflets. Eur J Heart Fail. 2017;19(11):1401-9. - PubMed
  18. Maggioni AP, Anker SD, Dahlström U, Filippatos G, Ponikowski P, Zannad F, et al.; Heart Failure Association of the ESC (HFA). Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2013;15(10):1173-84. - PubMed
  19. Teng TK, Tromp J, Tay WT, Anand I, Ouwerkerk W, Chopra V, et al.; ASIAN-HF Investigators. Prescribing patterns of evidence-based heart failure pharmacotherapy and outcomes in the ASIAN-HF registry: a cohort study. Lancet Glob Health. 2018;6(9):e1008-18. - PubMed
  20. Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, et al. Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry. J Am Coll Cardiol. 2018;72(4):351-66. - PubMed
  21. Ouwerkerk W, Teng TK, Tromp J, Tay WT, Cleland JG, van Veldhuisen DJ, et al. Effects of combined renin-angiotensin-aldosterone system inhibitor and beta-blocker treatment on outcomes in heart failure with reduced ejection fraction: insights from BIOSTAT-CHF and ASIAN-HF registries. Eur J Heart Fail. 2020;22(8):1472-82. - PubMed
  22. Brunner-La Rocca HP, Linssen GC, Smeele FJ, van Drimmelen AA, Schaafsma HJ, Westendorp PH, et al. Contemporary drug treatment of chronic heart failure with reduced ejection fraction: the CHECK-HF registry. JACC Heart Fail. 2019;7(1):13-21. - PubMed
  23. Savarese G, Bodegard J, Norhammar A, Sartipy P, Thuresson M, Cowie MR, et al. Heart failure drug titration, discontinuation, mortality and heart failure hospitalization risk: a multinational observational study (US, UKand Sweden). Eur J Heart Fail. 2021;23(9):1499-511. - PubMed
  24. Vardeny O, Claggett B, Packer M, Zile MR, Rouleau J, Swedberg K, et al.; Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) Investigators. Efficacy of sacubitril/valsartan vs. enalapril at lower than target doses in heart failure with reduced ejection fraction: the PARADIGM-HF trial. Eur J Heart Fail. 2016;18(10):1228-34. - PubMed
  25. Bitar S, Thilly N, Agrinier N. Sustained adherence to ESC guideline-recommended medications is associated with lower long-term mortality in heart failure and reduced ejection fraction: insights from the EPICAL2 cohort. J Clin Pharm Ther. 2020;45(4):793-803. - PubMed
  26. Packer M, Metra M. Guideline-directed medical therapy for heart failure does not exist: a non-judgmental framework for describing the level of adherence to evidence-based drug treatments for patients with a reduced ejection fraction. Eur J Heart Fail. 2020;22(10):1759-67. - PubMed
  27. Chioncel O, Collins SP, Ambrosy AP, Pang PS, Antohi EL, Iliescu VA, et al. Improving postdischarge outcomes in acute heart failure. Am J Ther. 2018;25(4):e475-86. - PubMed
  28. Lainščak M, Milinković I, Polovina M, Crespo-Leiro MG, Lund LH, Anker SD, et al.; European Society of Cardiology Heart Failure Long-Term Registry Investigators Group. Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry. Eur J Heart Fail. 2020;22(1):92-102. - PubMed
  29. White-Williams C, Rossi LP, Bittner VA, Driscoll A, Durant RW, Granger BB, et al.; American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Epidemiology and Prevention. Addressing social determinants of health in the care of patients with heart failure: a scientific statement from the American Heart Association. Circulation. 2020;141(22):e841-63. - PubMed
  30. Jarjour M, Henri C, de Denus S, Fortier A, Bouabdallaoui N, Nigam A, et al. Care gaps in adherence to heart failure guidelines: clinical inertia or physiological limitations? JACC Heart Fail. 2020;8(9):725-38. - PubMed
  31. Rossignol P, Lainscak M, Crespo-Leiro MG, Laroche C, Piepoli MF, Filippatos G, et al.; Heart Failure Long-Term Registry Investigators Group. Unravelling the interplay between hyperkalaemia, renin-angiotensin-aldosterone inhibitor use and clinical outcomes. Data from 9222 chronic heart failure patients of the ESC-HFA-EORP Heart Failure Long-Term Registry. Eur J Heart Fail. 2020;22(8):1378-89. - PubMed
  32. Veenis JF, Brunner-La Rocca HP, Linssen GC, Geerlings PR, Van Gent MW, Aksoy I, et al.; CHECK-HF Investigators. Age differences in contemporary treatment of patients with chronic heart failure and reduced ejection fraction. Eur J Prev Cardiol. 2019;26(13):1399-407. - PubMed
  33. Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19(12):1574-85. - PubMed
  34. Peterson PN, Rumsfeld JS, Liang L, Hernandez AF, Peterson ED, Fonarow GC, et al.; American Heart Association Get With The Guidelines-Heart Failure Program. Treatment and risk in heart failure: gaps in evidence or quality? Circ Cardiovasc Qual Outcomes. 2010;3(3):309-15. - PubMed
  35. DeVore AD, Mi X, Thomas L, Sharma PP, Albert NM, Butler J, et al. Characteristics and treatments of patients enrolled in the CHAMP-HF registry compared with patients enrolled in the PARADIGM-HF trial. J Am Heart Assoc. 2018;7(12):e009237. - PubMed
  36. Smeets M, Van Roy S, Aertgeerts B, Vermandere M, Vaes B. Improving care for heart failure patients in primary care, GPs' perceptions: a qualitative evidence synthesis. BMJ Open. 2016;6(11):e013459. - PubMed
  37. Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors - a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open. 2018;8(6):e021161. - PubMed
  38. McAlister FA, Youngson E, Kaul P, Ezekowitz JA. Early follow-up after a heart failure exacerbation: the importance of continuity. Circ Heart Fail. 2016;9(9):e003194. - PubMed
  39. Majumdar SR, McAlister FA, Furberg CD. From knowledge to practice in chronic cardiovascular disease: a long and winding road. J Am Coll Cardiol. 2004;43(10):1738-42. - PubMed
  40. Verhestraeten C, Heggermont WA, Maris M. Clinical inertia in the treatment of heart failure: a major issue to tackle. Heart Fail Rev. 2020;26(6):1359-70. - PubMed
  41. Ruppar TM, Cooper PS, Mehr DR, Delgado JM, Dunbar-Jacob JM. Medication adherence interventions improve heart failure mortality and readmission rates: systematic review and meta-analysis of controlled trials. J Am Heart Assoc. 2016;5(6):e002606. - PubMed
  42. Toback M, Clark N. Strategies to improve self-management in heart failure patients. Contemp Nurse. 2017;53(1):105-20. - PubMed
  43. Athilingam P, Jenkins B. Mobile phone apps to support heart failure self-care management: integrative review. JMIR Cardio. 2018;2(1):e10057. - PubMed
  44. Van Spall HGC, Rahman T, Mytton O, Ramasundarahettige C, Ibrahim Q, Kabali C, et al. Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. Eur J Heart Fail. 2017;19(11):1427-43. - PubMed
  45. Takeda A, Martin N, Taylor RS, Taylor SJ. Disease management interventions for heart failure. Cochrane Database Syst Rev. 2019;1(1):CD002752. - PubMed
  46. Matan D, Löfström U, Corovic Cabrera C, Eriksson B, Ekström M, Hage C et al. Reorganization of heart failure management and improved outcome - the 4D HF project. Scand Cardiovasc J. 2021;55(1):1-8. - PubMed
  47. Falstie-Jensen AM, Bogh SB, Hollnagel E, Johnsen SP. Compliance with accreditation and recommended hospital care-a Danish nationwide population-based study. Int J Qual Health Care. 2017;29(5):625-33. - PubMed
  48. Seferović PM, Piepoli MF, Lopatin Y, Jankowska E, Polovina M, Anguita-Sanchez M, et al.; Heart Failure Association Board of the European Society of Cardiology. Heart failure Association of the European Society of Cardiology Quality of Care Centres Programme: design and accreditation document. Eur J Heart Fail. 2020;22(5):763-74. - PubMed
  49. Lund LH. Pragmatic approaches to the next generation of clinical trials in heart failure. Eur Heart J Cardiovasc Pharmacother. 2020;6(5):282-3. - PubMed
  50. Koehler F, Koehler K, Deckwart O, Prescher S, Wegscheider K, Kirwan BA, et al. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet. 2018;392(10152):1047-57. - PubMed
  51. Salzano A, D'Assante R, Stagnaro FM, Valente V, Crisci G, Giardino F, et al. Heart failure management during the COVID-19 outbreak in Italy: a telemedicine experience from a heart failure university tertiary referral centre. Eur J Heart Fail. 2020;22(6):1048-50. - PubMed
  52. Bhatt DL, Szarek M, Steg PG, Cannon CP, Leiter LA, McGuire DK, et al.; SOLOIST-WHF Trial Investigators. Sotagliflozin in patients with diabetes and recent worsening heart failure. N Engl J Med. 2021;384(2):117-28. - PubMed
  53. Zannad F, Ferreira JP, Pocock SJ, Anker SD, Butler J, Filippatos G, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-reduced and DAPA-HF trials. Lancet. 2020;396(10254):819-29. - PubMed
  54. Docherty KF, Jhund PS, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al. Effects of dapagliflozin in DAPA-HF according to background heart failure therapy. Eur Heart J. 2020;41(25):2379-92. - PubMed
  55. Berg DD, Jhund PS, Docherty KF, Murphy SA, Verma S, Inzucchi SE, et al. Time to clinical benefit of dapagliflozin and significance of prior heart failure hospitalization in patients with heart failure with reduced ejection fraction. JAMA Cardiol. 2021;6(5):499-507. - PubMed
  56. Martinez FA, Serenelli M, Nicolau JC, Petrie MC, Chiang CE, Tereshchenko S, et al. Efficacy and safety of dapagliflozin in heart failure with reduced ejection fraction according to age: insights from DAPA-HF. Circulation. 2020;141(2):100-11. - PubMed
  57. Zannad F, Ferreira JP, Pocock SJ, Zeller C, Anker SD, Butler J, et al. Cardiac and kidney benefits of empagliflozin in heart failure across the spectrum of kidney function. Circulation. 2021;143(4):310-21. - PubMed
  58. Packer M, Anker SD, Butler J, Filippatos G, Ferreira JP, Pocock SJ, et al.; EMPEROR-Reduced Trial Committees and Investigators. Empagliflozin in patients with heart failure, reduced ejection fraction, and volume overload: EMPEROR-Reduced trial. J Am Coll Cardiol. 2021;77(11):1381-92. - PubMed
  59. Ferreira JP, Zannad F, Pocock SJ, Anker SD, Butler J, Filippatos G, et al. Interplay of mineralocorticoid receptor antagonists and empagliflozin in heart failure: EMPEROR-reduced. J Am Coll Cardiol. 2021;77(11):1397-407. - PubMed
  60. Vaduganathan M, Claggett BL, Jhund PS, Cunningham JW, Pedro Ferreira J, Zannad F, et al. Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials. Lancet. 2020;396(10244):121-8. - PubMed
  61. Rosano GMC, Moura B, Metra M, Böhm M, Bauersachs J, Ben Gal T, et al. Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2021;23(6):872-81. - PubMed

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