Knowledge and application of ESC/HFA guidelines in the management of advanced heart failure

Guillaume Baudry; Nicolas Girerd; Maja Cikes; Maria Generosa Crespo-Leiro; Kevin Damman; Clément Delmas; Stamatis Adamopoulos; Sanem Nalbantgil; Hoong Sern Lim; Frank Ruschitzka; Marco Metra; Finn Gustafsson

doi:10.1002/ejhf.3530

Knowledge and application of ESC/HFA guidelines in the management of advanced heart failure

Eur J Heart Fail. 2024 Nov 19. doi: 10.1002/ejhf.3530. Online ahead of print.

Authors

Guillaume Baudry^{1

2

3}, Nicolas Girerd^{1

3}, Maja Cikes⁴, Maria Generosa Crespo-Leiro^{5

6

7}, Kevin Damman⁸, Clément Delmas^{3

9}, Stamatis Adamopoulos¹⁰, Sanem Nalbantgil¹¹, Hoong Sern Lim^{12

13}, Frank Ruschitzka¹⁴, Marco Metra¹⁵, Finn Gustafsson¹⁶

Affiliations

¹ Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.
² REICATRA, Université de Lorraine, Vandoeuvre-les-Nancy, France.
³ INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France.
⁴ Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Center Zagreb, Zagreb, Croatia.
⁵ Cardiology Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain.
⁶ Centro de Investigación Biomedica en Red Cardiovascular (CIBERCV), Madrid, Spain.
⁷ Faculty of Medicine, Universidade da Coruña (UDC), A Coruña, Spain.
⁸ University of Groningen, Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands.
⁹ Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, Toulouse, France.
¹⁰ Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, Athens, Greece.
¹¹ Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey.
¹² Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
¹³ University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹⁴ Department of Cardiology, University Heart Center, University Hospital Zurich, Zürich, Switzerland.
¹⁵ Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
¹⁶ Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

PMID: 39563177
DOI: 10.1002/ejhf.3530

Abstract

Aims: Management of advanced heart failure (HF) remains challenging despite specific sections in the 2021 European Society of Cardiology/Heart Failure Association (ESC/HFA) guidelines, with delays in referrals exacerbating the issue. This study aimed to evaluate the awareness and implementation of these guidelines among cardiologists and identify barriers to effective referral.

Methods and results: From June to October 2023, an online survey was disseminated through the ESC mailing list, targeting cardiologists across Europe. The survey investigated four areas: guideline awareness, healthcare network organization, clinical case management, and perceptions of mechanical circulatory support (MCS) outcomes. Respondents were categorized into heart failure cardiologists (HFCs), general cardiologists (GCs), and other participants (OPs). Among 497 respondents, 25% were heart HFCs, 40% were GCs, and 35% were OPs. A total of 84% of HFCs reported a high level of guideline knowledge, compared to 57% of GCs and 62% of OPs (p < 0.001). Additionally, 76% of HFCs 'regularly or always' used ESC/HFA criteria to identify advanced HF, compared to 44% of GCs and 48% of OPs (p < 0.001). Correct responses regarding the recommendation class for heart transplantation were 84%, 55%, and 60% (p < 0.0001), and for MCS as a bridge to transplantation, 69%, 65%, and 55% (p = 0.018) among HFCs, GCs, and OPs, respectively. Referring patients with severe HF to a tertiary centre team was found to be 'very difficult' or 'difficult' by 8.4% of HFCs, 19.6% of GCs, and 18.2% of OPs (p = 0.0005).

Conclusion: The study highlights significant disparities in knowledge and application of advanced HF guidelines among cardiologists, revealing an opportunity for educational initiatives. The difficulty in referring patients to tertiary centres underscores the need to improve the referral pathway for advanced HF patients.

Keywords: Advanced heart failure; Cardiologist education; ESC/HFA guidelines; Healthcare networks; Mechanical circulatory support; Transplantation.