Ricerc@Sapienza

Heart failure (HF) is a clinical syndrome responsible for a high hospitalization rate and mortality with a significant reduction in quality of life. It affects a sizable portion of the adult population, and its prevalence increases with age [1]. Across the spectrum of HF, patients affected by heart failure with reduced ejection fraction (HFrEF) have the worst prognosis [2]. When compared to the results of the first treatment trials, prognosis has markedly improved thanks to new effective evidence-based therapeutic options. Recent trials promoted new molecules as emerging therapies for HFrEF to reduce mortality and hospitalization rates [3‒7] (shown in Fig. 1). However, there is often a gap between clinical features of patients enrolled in randomized clinical trials (RCTs) and real-world patients seen in clinical practice, especially those at higher clinical risk. This mismatch results in difficulty to validate the efficacy data from RCTs and to translate them in clinical practice [8, 9]. HF mainly affects the elderly, patients with chronic kidney disease (CKD), patients with diabetes mellitus (DM), patients with coronary artery disease (CAD); it is not clear how the new therapies for HFrEF perform in these subgroups and in other specific patient populations: patients in New York Heart Association (NYHA) class III–IV, women, patients on or off sacubitril/valsartan therapy. The aim of this analysis was the evaluation of the efficacy of different HF drugs in specific subgroups of HFrEF patients, for whom clinical management is particularly challenging.