Evaluating Adherence to Guideline-Directed Medical Therapy in Patients With Advanced Heart Failure
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: GDMT, Quality of life questionnaire.
- Who it may be relevant to
- Registry conditions: Heart Failure. Basic parameters: 18 years — 75 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Italy
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Official title
Evaluating Adherence to Guideline- Directed Medical Therapy Using the Four-Pillar Strategy in Patients With Advanced Heart Failure: the Advanced Heart Failure Unified Board (Ad-HUB) Study
Overview
A Prospective Observational, Multi-Center, Real-World Pharmacological Study Evaluating Adherence to Guideline-Directed Medical Therapy Using the Four-Pillar Strategy in Patients with Advanced Heart Failure
Detailed description
A Prospective Observational, Multi-Center, Real-World Pharmacological Study Evaluating Adherence to Guideline-Directed Medical Therapy Using the Four-Pillar Strategy in Patients with Advanced Heart Failure. Patients will be managed according to routine clinical practice, and no additional treatments are required as part of participation in this study.
As this is an observational study, data on the pharmacological therapies taken by the patients according to routine clinical practice will be recorded, without any modification resulting from participation in the present study. The medications are therefore in the patients' possession and are taken orally according to medical prescription, in accordance with the dosages and indications provided in the package leaflet.
In particular, GDMT consists of a combination of four classes of medications, which each patient may receive: one renin-angiotensin-aldosterone system drug, one beta-blocker, one mineralcorticoid receptor antagonist and one SGLT2 Inhibitor.
Interventions
- Drug GDMT
Percentage of patients receiving GDMT in advanced heart failure - Other Quality of life questionnaire
Absoute Quality of life questionnaire scores (SF 36 questionnaire and EqVAS scale, both validated in Italian language
Primary outcome measures
- assess the adherence to guideline-directed medical therapy in patients with advanced heart failure [Time frame: 3 months, 6 months, 1 year, 2 years, 5 years]
Secondary outcome measures (1)
- assess the level of quality of life in patients under study [Time frame: 3 months, 6 months, 1 year, 2 years, 5 years]
Eligibility criteria
Inclusion criteria
- Age > 18 and < 75 years
- Heart failure with left ventricular ejection fraction ≤ 35%
- Persistent symptoms of heart failure, New York Heart Association class III or IV
- Requirement for high-dose diuretic therapy, specifically Furosemide > 50 mg/day orally as per routine clinical practice
- At least one of the following additional indicators of severity or refractoriness:
- need for progressive escalation of diuretics,
- intolerance to optimized medical therapy,
- persistence of symptoms despite advanced treatments such as (but not limited to) cardiac resynchronization therapy (CRT-D)and/or MitraClip
- Ability and willingness to provide written informed consent for participation and for the processing of clinical data for research purposes
Exclusion criteria
- Age ≤ 18 years or ≥ 75 years
- Left ventricular ejection fraction > 35%
- Mild or absent symptoms (New York Heart Association class I-II)
- Good response to optimized conventional guideline-directed medical therapy
- Extreme frailty or severe non-reversible disability, or psychiatric or cognitive disorders preventing adherence to follow-up
- Pregnant or breastfeeding women
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Cohort
Study locations
Italy · 2 centers
- ASST Ospedale Papa Giovanni XXIII — Bergamo
- IRCCS Ospedale San Raffaele — Milan
Publications
- European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail. 2017 Mar;19(3):438. doi: 10.1002/ejhf.772. No abstract available. PMID 28251778
- Adamo M, Gardner RS, McDonagh TA, Metra M. The 'Ten Commandments' of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2022 Feb 10;43(6):440-441. doi: 10.1093/eurheartj/ehab853. No abstract available. PMID 34922348
- Tannenbaum C, Ellis RP, Eyssel F, Zou J, Schiebinger L. Sex and gender analysis improves science and engineering. Nature. 2019 Nov;575(7781):137-146. doi: 10.1038/s41586-019-1657-6. Epub 2019 Nov 6. PMID 31695204
- Piano per l'applicazione e la diffusione della medicina di genere - Ministero della Salute, 2021.
- Regolamento (UE) 2017/745 sui dispositivi medici.
- Regione Lombardia. Deliberazione della Giunta Regionale n. XI/3522 del 5 agosto 2020. "Indicazioni e requisiti per l'ulteriore efficientamento organizzativo della rete cardiovascolare regionale". Milano: Regione Lombardia; 2020.Regolamento (UE) 2016/679 del Parlamento Europeo e del Consiglio del 27 aprile 2016 (GDPR).
- SAGER Guidelines - Sex and Gender Equity in Research.
- Baksh G, Haydo M, Frazier S et al Improving Utilization of Guideline-Directed Medical Therapy for Heart Failure J Nurse Pract 2024;20:105108
Identifiers
NCT: NCT07560982 · Ad-HUB Study