Implementation of guideline-directed medical therapy among patients with acute heart failure admitted to cardiac rehabilitation: the PROMETEO registry.

Background and aims: To provide a contemporary description of patients referred to cardiac rehabilitation (CR) in Italy after hospitalization for acute heart failure (HF), focusing on the use and optimization of guideline-directed medical therapy (GDMT) across the spectrum of left-ventricular ejection fraction (LVEF). Methods: PROMETEO is a prospective, multicentre Italian registry enrolling consecutive adult patients admitted to CR after acute HF. Patients were stratified as HFrEF (LVEF <40%) or HFmrEF/HFpEF (LVEF ≥40%). Results: Among 263 patients with available LVEF, median age was 68.7 years, 21.7% were female, and 74.9% had HFrEF. Compared with HFmrEF/HFpEF, HFrEF were younger, less frequently female and with higher NT-proBNP levels. At CR admission, 72.1% of HFrEF patients received ACEi/ARB/ARNI, 91.9% beta-blockers, 79.2% MRAs, and 66.0% SGLT2 inhibitors, with a median GDMT score of 6 (IQR 4-8). At discharge, ARNI use increased significantly (58.9%) and the median GDMT score increased to 7 (IQR 4-8; Conclusion: Patients referred to CR after acute HF are mainly male with HFrEF and show substantial comorbidity and treatment complexity. Residential CR represents a key opportunity for GDMT optimization across the HF spectrum.