Multidisciplinary Cardiac Case Conference for Guideline-Directed Therapy Optimisation and LV Recovery in High-Risk HfrEF

Presenter: N Sowden

Therapeutic inertia remains a persistent challenge to guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF), particularly among patients with advanced chronic kidney disease (CKD), frailty, and established HF. A study evaluated whether a weekly multidisciplinary cardiac case conference (MDCC) alongside standard care could support treatment optimisation and left ventricular (LV) recovery. The MDCC comprised nurse practitioner case presentation, pharmacist review, and Heart Failure Specialist input. Among 89 HFrEF patients, quadruple therapy increased from 45% to 82% (p<0.001), while mean left ventricular ejection fraction (LVEF) improved by 12.1±10.8% (p<0.001); 66% improved LVEF category and 37% achieved LVEF ≥50%. Patients with CKD and frailty also achieved safe optimisation without significant changes in renal dysfunction, hyperkalaemia, or medication-related admissions. LV recovery was particularly pronounced among those with 2–5 months of HF: 56% achieved LVEF ≥50%, versus 29% with ≥12 months of HF. Overall, the MDCC helped overcome therapeutic inertia, with reported clinical benefits across comorbidity profiles and an efficient, cost-effective model of care.

iCaReMe Global Registry Analysis: Changes in Guideline-Directed Therapy Adoption After the 2023 ESC HF Update

Presenter: R Silva-Tinoco

The 2023 European Society of Cardiology (ESC) Focused Update introduced Class I recommendations for sodium-glucose co-transporter-2 inhibitors (SGLT2i) across the ejection fraction spectrum, prompting evaluation of real-world changes in guideline-directed medical therapy (GDMT) adoption. An analysis of the iCaReMe Global Registry included 3,147 adults with HF from 18 countries across Asia-Pacific, Latin America, and Middle East and Africa, comparing 2,434 patients enrolled from 2020-August 2023 with 713 enrolled from September 2023-2024. Patients in the later period were older (61.5 vs. 58.5 years; p<0.0001) and had a higher prevalence of chronic kidney disease (29.9% vs. 23.0%; p=0.0002). SGLT2i use increased from 51.0% to 56.2% (p=0.0135), while mineralocorticoid receptor antagonist (MRA) use rose from 51.2% to 56.5% (p=0.0129). SGLT2i use in HFmrEF/HFpEF increased from 34.8% to 49.7% (p<0.0001). In HFrEF, quadruple therapy increased from 37.9% to 43.3% (p=0.0574), but remained below 50%, indicating persistent gaps in comprehensive GDMT implementation.

Empagliflozin and Quality-of-Life Outcomes Across Age and Comorbidity Profiles: EMP-Activity Real-World Study

Presenter: A Tomaszuk-Kazberuk

ESC guidelines recommend empagliflozin across the HF ejection fraction spectrum, but whether quality-of-life (QoL) gains are consistent across age and comorbidity profiles remains unclear. The prospective, non-interventional EMP-Activity study evaluated QoL changes over 24 weeks using the Kansas City Cardiomyopathy Questionnaire (KCCQ) in 3,108 empagliflozin-treated patients across six European countries. Mean KCCQ Overall Summary Score increased by 17.3±18.4 points in patients <65 years and 16.1±19.1 points in those ≥65 years, with clinically meaningful improvement in 76.3% and 71.6%, respectively. Patients with type 2 diabetes had slightly greater mean improvement than those without diabetes (17.5±19.4 vs 16.3±18.7 points), whereas those with chronic kidney disease had smaller gains than those without CKD (9.2±15.8 vs 17.0±19.0 points) and more frequent worsening (13.3% vs 7.5%). New York Heart Association (NYHA) class I/II increased by approximately 15% across subgroups, but by approximately 10% in CKD. Overall, QoL improvements were observed across age and comorbidity groups, although CKD attenuated these gains and increased the risk of decline.

ESC Congress 2026, 28 - 31 Aug, Munich, Germany