ESC Congress 2026 Abstract · Oct 26, 2026
Clinical profile and implementation of guideline-directed medical therapy in specialised heart failure clinics: insights from a multicentre registry
By Rossel Mariangel V, Mino C, Castro C et al.
Background: Specialised Heart Failure (HF) clinics are designed to improve the implementation of guideline-directed medical therapy (GDMT). However, contemporary multicentre real-world data on patient profiles and treatment optimisation in specialised outpatient settings remain limited. Purpose: To characterise the clinical profile, laboratory biomarkers, and implementation of GDMT in outpatients with HF with reduced ejection fraction (HFrEF) followed in specialized clinics, with a specific focus on sex and age-related differences. Methods: This prospective national multicentre registry included 1,099 outpatients with HFrEF (left ventricular ejection fraction ≤40%). Demographic characteristics, laboratory parameters, and GDMT use were analysed, including beta-blockers, mineralocorticoid receptor antagonists (MRA), sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and renin-angiotensin system (RAS) inhibitors. Subgroup comparisons were performed according to sex and age (age ≥75 vs <75 years) using appropriate statistical tests. Results: Median age was 64 years (IQR 56–72) and 27.8% were women. Median left ventricular ejection fraction was 29% (IQR 23–34). Ischaemic aetiology predominated (47.5%) and 17% had atrial fibrillation. Overall GDMT implementation was high: beta-blockers 96.2%, MRA 88.1%, and SGLT-2 inhibitors 81.4%. Regarding RAS inhibition, 44.2% received angiotensin receptor-neprilysin inhibitors, 25.3% angiotensin receptor blockers, and 21.9% angiotensin-converting enzyme inhibitors. Men showed a higher prevalence of ischaemic aetiology (56% vs 32%, p<0.001), higher creatinine (1.11 vs 0.89 mg/dL, p<0.001), and higher haemoglobin levels (14.9 vs 13.5 g/dL, p<0.001). Patients aged ≥75 years (18%) had more hypertension (78% vs 61%, p<0.001), atrial fibrillation (17% vs 10%, p=0.002), higher NT-proBNP (1,611 vs 1,065 pg/mL, p=0.003), higher creatinine (1.20 vs 1.01 mg/dL, p<0.001) and lower haemoglobin (13.7 vs 14.6 mg/dL, p<0.001). Quadruple foundational therapy was less frequent in older patients (51% vs 66%, p<0.001). Conclusions: In a large national multicentre specialized HF clinic registry, GDMT implementation was high overall. Sex-related differences were mainly driven by aetiology and laboratory profile, without major disparities in therapeutic implementation. In contrast, older patients exhibited a higher comorbidity burden, worse biomarker profile, and significantly lower optimisation of quadruple therapy, highlighting a persistent therapeutic gap in this high-risk population.Table1_Sex DifferencesTable2_Age Differences