Heart failure & cardiomyopathiesCohort study
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
- Prospective observational cohort study
- multicentre
- 48 hospitals in the Netherlands
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
- De novo vs Chronic vs Worsening
- De novon = 1,353
Main finding
As reported in the abstract
Composite of:
- All-cause death
- HF hospitalization
| 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% |
- 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 guideline-recommended medical therapy (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:10.1002/ejhf.70006
Summarised from the published abstract; every number is checked against it