Heart failure & cardiomyopathies
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
Authors' conclusion
These 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.
Study context
- Population
- Patients with HFrEF, 48 Dutch hospitals, June 2022–February 20244,288 enrolled
- Participants
- 3,367 patients
- Exposure
- Guideline-recommended medical therapy (GRMT) implementation across HFrEF stages: de novo vs chronic vs worsening heart failure (HF)
- De novon = 1,353
- Outcome
- Composite of:
- All-cause death
- HF hospitalization
- Follow-up
- 12 months
Methodological detailsmulticentre, 48 hospitals in the Netherlands
- Multicentre
- 48 hospitals in the Netherlands
Main finding
As reported in the abstract
| Group | Value | Quadruple therapy at 6 weeks | Quadruple therapy at 3 months | Quadruple therapy at 6 months | Quadruple therapy at 12 months |
|---|---|---|---|---|---|
| De novo | 13.3% | 47.2% | 64.7% | 69.5% | 64.4% |
| Chronic | 13.3% | ||||
| Worsening | 43.8% |
Value
De novo13.3%
Chronic13.3%
Worsening43.8%
Quadruple therapy at 6 weeks
De novo47.2%
Chronic— not stated in the abstract
Worsening— not stated in the abstract
Quadruple therapy at 3 months
De novo64.7%
Chronic— not stated in the abstract
Worsening— not stated in the abstract
Quadruple therapy at 6 months
De novo69.5%
Chronic— not stated in the abstract
Worsening— not stated in the abstract
Quadruple therapy at 12 months
De novo64.4%
Chronic— not stated in the abstract
Worsening— not stated in the abstract
- Chronic/worsening HFrEF (n = 1625): quadruple therapy baseline → 12 months
- 44.6% to 54.6%
- Chronic/worsening HFrEF: SGLT2 inhibitor uptake baseline → 12 months
- 66.0% to 78.5%
Observational data: associations, not effects.
Further findings
Median
| Outcome | Ischaemic | Non-ischaemic | P value |
|---|---|---|---|
| Median LVEF improvement, de novo HFrEF with serial echocardiograms (n = 752), by cardiomyopathy type · 12 months | 10% (IQR 3–17%) | 15% (IQR 9–24%) | P < 0.001 |
Median left ventricular ejection fraction (LVEF) improvement, de novo HFrEF with serial echocardiograms (n = 752), by cardiomyopathy type · 12 months
- Early quadruple GRMT initiation (within 6 weeks) and higher 6-month doses associated with greater LVEF improvement
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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. Eur J Heart Fail. Published 14 August 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →