Management of patients with heart failure treated in cardiology consultations: IC-BERG Study

• Published in: Revista clínica espanõla (English edition) Vol. 220; no. 6; pp. 339 - 349
• Main Authors: Barrios, V, Escobar, C, Ortiz Cortés, C, Cosín Sales, J, Pascual Figal, D A, García-Moll Marimón, X
• Format: Journal Article
• Language: English; Spanish
• Published: 01-08-2020
• ISSN: 2254-8874
• DOI: 10.1016/j.rce.2019.10.011

OBJECTIVETo determine the perception and management of heart failure with reduced ejection fraction (HFrEF) by clinical cardiologists and to establish a consensus with recommendations. METHODSWe employed the modified Delphi method among a panel of 150 experts who answered a questionnaire that included three blocks: definition and perception of patients with «stable» HFrEF (15 statements), management of patients with «stable» HFrEF (51 statements) and recommendations for optimising the management and follow-up (9 statements). The level of agreement was assessed with a Likert 9-point scale. RESULTSA consensus of agreement was reached on 49 statements, a consensus of disagreement was reached on 16, and 10 statements remained undetermined. There was consensus regarding the definition of «stable» HF (82%), that HFrEF had a silent nature that could increase the mortality risk for mildly symptomatic patients (96%) and that the drug treatment should be optimised, regardless of whether a patient with HFrEF remains stable in the same functional class (98.7%). In contrast, there was a consensus of disagreement regarding the notion that treatment with an angiotensin receptor-neprilysin inhibitor is justified only when the functional class worsens (90.7%). CONCLUSIONSOur current understanding of «stable» HF is insufficient, and the treatment needs to be optimised, even for apparently stable patients, to decrease the risk of disease progression.