Renal-based Optimization of QUADruple Therapy in Patients With Heart Failure With Reduced Ejection Fraction.

Renal-based Optimization of QUADruple Therapy in Patients With Heart Failure With Reduced Ejection Fraction: a Prospective, Multicentre, International Randomized Study

The goal of this clinical trial is to evaluate guideline-directed medical therapy (GDMT) up-titration in patients with heart failure with reduced ejection fraction.The main question it aims to answer is the improvement in prescription rate and dose uptitration of quadruple GDMT in patients with HFrEF, assessed by a weighed composite score.

Participants will be randomized towards control (standard of care, SOC) or intervention group.

Researchers will compare SOC with protocol-based up-titration to see if the protocolized optimization improves prescription rate of GDMT.

Inclusion Criteria:

• Left ventricular ejection fraction ≤ 40%, assessed LVEF with imaging within last three months before randomization (TTE/KT/MIBI/MRI)
• NYHA ≥ II

Exclusion Criteria:

• Hemodynamic instability
• Recent acute coronary syndrome (< 1 month before randomisation)
• Already on quadruple heart failure therapy or on triple GDMT in case of eGFR < 30ml/min/1.73m2 or a potassium above 6mmol/L
• eGFR < 20ml/min/1.73², planned for dialysis or already actively treated with chronic dialysis.
• Implantation of a cardiac resynchronization therapy (CRT) within 3 months
• Adult congenital heart disease
• Previous heart transplantation or currently/planned for ventricular assist device
• Women who are pregnant or breastfeeding
• Unable to participate in 3 months follow-up