CONGRESS ABSTRACT

Introduction Growing evidences suggest that an early and accelerated use of the four pillars for the treatment of acute decompensated heart failure (ADHF) may be recommended to reduce cardiovascular morbidity and mortality accross the entire spectrum of ejection fraction (EF). The aim of our study is to establish safety and tolerability of this therapeutic regimen during hospitalization. Methods We retrospectively collected data from 178 consecutive patients admitted to our Department with a diagnosis of heart failure from August 2023 to April 2024. We compared the utilization of the four pillars together with data of systolic arterial pressure, creatinine, glomerular filtration rate (GFR), kaliemia, and haemoglobin values at admission and at discharge. Results Patients had a mean age of 76.1±11, and 62% were male. The mean BMI was 27.1±4 and 29% of the patients had diabetes. Patients with HFrEF represent 39,9% of the total, HFmrEF 23% and HFpEF 37,1%. The utilization of ACEi/ARB and ARNi at admission was 58,3% up to 82,5% at discharge. Among patients with HFrEF ARNi prescription increased from 31% to 69%. SGLT2i prescription at admission was 23% up to 75,8% at discharge. Beta-blockers and MRA utilization increased from 65.7% to 87.6% and from a 32,5% to 80,3%, respectively. Both haemoglobin values and systolic arterial pressure decreased during hospitalization, from 13±1.7g/dl to 12.7±1.9 g/dl (p=0.00013) and from 128.7±15 mmHg to 119.8±19 mmHg (p<0.0001), respectively.  Creatinine levels moved from 1.32±0.5 to 1.38±0.5 mg/dl (p=0.007), while GFR reduced from 55±24 ml/min to 51±20 ml/min (p=0.0005), significantly. Kaliemia reduced from 4.05±0.4 to 3.97±0.4 mEq/l (p=0.044). Among patients who didn’t receive SGLT2i, only 11 patients (6.1%) had an absolute contraindication represented by a GFR < 25 ml/min. Discussion Our data confirm that the prescription rate of the four pillars for the treatment of HF increased significantly at discharge. Furthermore, our preliminary data confirm the feasibility of early use of an accelerated therapy following an episode of ADHF. In fact, despite a mild reduction of haemoglobin, a mild drop of systolic arterial pressure, creatinine value and GFR as expected, the treatment was safe and tolerable and don’t significantly affect key clinical and laboratory parameters. Approximately 20% of patients had no evident clinical reasons for not receiving SGLT2i, probably due to therapeutic inertia.