Clinical Management Strategies of Cardiologists in Heart Failure with Reduced Ejection Fraction in Türkiye

OBJECTIVE
Implementing heart failure (HF) guideline recommendations into clinical practice takes time, and is usually suboptimal in real-life setting. Physician–related factors may be an important barriers to guideline implementation. This survey aims to determine the current opinions of cardiologists practicing in Türkiye about the management of HF with reduced ejection fraction (HFrEF).

METHODS
The survey material was composed of twenty-two individual questions and published on the SurveyMonkey platform.

RESULTS
Overall, 177 cardiologists (mean age: 39.5 years and 73.3% male) completed the survey, of which 38.7% were practicing in an education&research hospital and 10.2% were HF-specialists. The cut-off EF value to define HFrEF was ≤40% for 80.1% of the cardiologists. Although ARNi treatment was considered the most efficient HF medication for 52.6% of physicians, 62.7% of the study participants would initiate to HF treatment with an ACEi instead of ARNi due to reimbursement regulations and cost issues. More than half of the cardiologists (52.3%) declared that adding another class of HF medication is more important than up-titrating those already started. Although 69.5% of the study participants stated that it is possible to prescribe all four classes of HF medications during the index hospitalization period, the majority of cardiologists preferred the sequential approach which starts with ACEi/ARNi first, beta–blockers second, MRAs third, and SGLT2i fourth.

CONCLUSION
The present survey demonstrated that there are significant gaps between guideline recommendations and real-life clinical practice of cardiologists in Türkiye. These results suggest that there is a need for organized action by healthcare providers to improve implementation of guideline recommendations.