Adherence to drug therapy in patients with heart failure associated with reduced ejection fractions (HFrEF) during cardiac rehabilitation and after 3 and 6 months

Clin Res Cardiol. 2024 Jun;113(6):866-874. doi: 10.1007/s00392-023-02314-0. Epub 2023 Oct 5.

Abstract

Introduction: Heart failure represents a major challenge for healthcare systems worldwide. Rehabilitation is recommended as an important pillar of therapy for these patients, especially for those with reduced left ventricular ejection fraction (HFrEF: heart failure with reduced ejection fraction).

Methods: The data collected in this multi-center project provide information on the rates of patients with HFrEF who were treated in five German rehabilitation facilities and whether the patients adhered to drug therapy at 3-/6-month follow-up. The project was supported by an unrestricted grant from Novartis-Pharma-GmbH.

Results: The mean age of the 234 patients included was 63.4 ± 10.6 years and 78% were male. The mean LVEF was 31 ± 8% at admission and 36 ± 10% at discharge. Only 20.6% of the patients were assigned to rehabilitation with the main indication HF. The most frequent main indication was acute coronary syndrome (46.6%). A high proportion of patients was already on the recommended drug therapy upon admission (94% beta blockers, 100% angiotensin-effective drugs, 70% mineralocorticoid receptor antagonists, etc.). This was optimized, in particular by a higher proportion of patients treated with sodium-glucose cotransporter-2 inhibitors (35% admission vs. 45% discharge) and sacubitril/valsartan (49% admission vs. 64% discharge), which was further optimized during the 6-month follow-up (e.g., 50% SGLT2 inhibitors, 67% sacubitril/valsartan).

Discussion: These data illustrate the effect of rehabilitation in terms of optimizing drug therapy, which stabilized over the course of 6 months. Furthermore, only a few patients with the main diagnosis HFrEF are referred for cardiac rehabilitation, although it is an essential part of guideline-based therapy.

Keywords: Drug therapy; Heart failure; Heart failure with reduced ejection fraction (HFrEF); Rehabilitation.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aminobutyrates / therapeutic use
  • Angiotensin Receptor Antagonists / therapeutic use
  • Biphenyl Compounds / therapeutic use
  • Cardiac Rehabilitation* / methods
  • Cardiovascular Agents / therapeutic use
  • Drug Combinations
  • Female
  • Follow-Up Studies
  • Germany / epidemiology
  • Heart Failure* / drug therapy
  • Heart Failure* / physiopathology
  • Heart Failure* / rehabilitation
  • Humans
  • Male
  • Medication Adherence* / statistics & numerical data
  • Middle Aged
  • Stroke Volume* / physiology
  • Time Factors
  • Treatment Outcome
  • Valsartan / therapeutic use
  • Ventricular Function, Left / physiology

Substances

  • sacubitril and valsartan sodium hydrate drug combination