Opinion on the 2021 ESC guidelines on heart failure: a cross-sectional survey of 387 doctors

Introduction and objectives: Our aim was to assess the degree of acceptance of the European clinical practice guidelines (CPG) on heart failure (HF) among Spanish physicians. Methods: Cross-sectional study conducted via a Google form, distributed by a group of HF experts from the Community of Madrid between November 2021 and February 2022, among specialists and residents of Cardiology, Internal Medicine and Primary Care from Spain. Results: A total of 387 doctors participated (mean age 39.5 ± 10.3 years, 45% women), from 128 centers (60% from the Community of Madrid and 40% from other regions). The most represented specialty was Cardiology (76%), followed by Internal Medicine (20%), and Primary Care (4%); 37% of them were HF physicians. On a scale of 1 to 10, participants scored the CPG with a mean of 7.7 ± 1.3 points. The best valued aspect was the positioning of the quadruple therapy at the same level (192, 50%), and the majority considered necessary to develop specific protocols for its implementation (353, 91%). Management (adjustment of diuretics, monitoring, antidiabetics, etc.) of sodium-glucose co-transporter type 2 inhibitors (SGLT2i) in patients with HF and reduced left ventricular ejection fraction (LVEF) was positive among the participants, but a relatively low use in other scenarios was observed. Conclusions: Although the new CPG on HF have been well received, the need to develop clinical protocols to facilitate its implementation is detected. SGLT2i are managed on an outpatient basis in patients with HF and reduced LVEF, but there are clinical scenarios (hospitalization and preserved LVEF) where their use can be increased.