Observational studyEuropean journal of heart failure2025
Real-life implementation of guideline-recommended medical therapy in heart failure with reduced ejection fraction: Effects on prognosis and left ventricular ejection fraction. Primary results of TITRATE-HF.
Observational study in European journal of heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Heart failure evidence update 2026.Heart failure reviews · 2026Review
Corrections and comments
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Authors and funding
16 authors.
Funding
Abstract
aimsGuideline-recommended medical therapy (GRMT) improves outcomes in heart failure (HF) with reduced ejection fraction (HFrEF), yet implementation remains suboptimal. TITRATE-HF prospectively evaluated GRMT implementation across different HFrEF stages, and its effect on 1-year prognosis and left ventricular ejection fraction (LVEF). METHODS AND
resultsTITRATE-HF is an observational cohort study across 48 hospitals in the Netherlands (June 2022-February 2024). A total of 4288 patients were enrolled. This primary analysis includes 12-month follow-up data of all HFrEF patients (n = 3367), stratified into de novo, chronic, and worsening HF. Longitudinal trends in GRMT prescription rates and dosages were analysed. Serial echocardiographic data assessed changes in LVEF between baseline and 12 months. Kaplan-Meier analysis assessed the composite endpoint of all-cause death or HF hospitalization. Median age was 71 years (interquartile range [IQR] 63-78), 29% were female, and 56% had non-ischaemic cardiomyopathy. In de novo HFrEF (n = 1353), quadruple therapy was 47.2% at 6 weeks, 64.7% at 3 months, 69.5% at 6 months, and 64.4% at 12 months. In chronic/worsening HFrEF (n = 1625), quadruple therapy increased from 44.6% at baseline to 54.6% at 12 months, primarily driven by greater sodium-glucose co-transporter 2 inhibitor uptake (66.0% to 78.5%). Among de novo HFrEF patients with serial echocardiograms (n = 752), median LVEF improved by 10% (IQR 3-17%) in ischaemic versus 15% (IQR 9-24%) in non-ischaemic cardiomyopathy (p < 0.001). Early quadruple GRMT initiation (within 6 weeks) and higher 6-month doses were associated with greater LVEF improvement. At 12 months, the composite endpoint occurred in 13.3%, 13.3%, and 43.8% of de novo, chronic, and worsening HFrEF patients, respectively.
conclusionsThese findings highlight the importance of early and intensive GRMT implementation, and emphasize the need for continuous dose titration beyond the initial phase to improve LVEF and clinical outcomes.
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