[PONTE-HF/ACS registry: optimization of medical therapy in outpatient clinics in Apulia for patients with heart failure].

The PONTE-HF/ACS registry enrolled 1203 patients with heart failure between January 2024 and September 2025, distributed across four ejection fraction categories.

• 496 patients had HF with reduced ejection fraction (HFrEF)
• 189 patients had HF with mildly reduced ejection fraction (HFmrEF)
• 302 patients had HF with preserved ejection fraction (HFpEF)
• 216 patients had HF with improved ejection fraction

In HFrEF patients, ACEi/ARB/ARNi therapy was prescribed in 89% of cases after enrollment, with ARNi comprising the majority of prescriptions.

• ACEi/ARB/ARNi was prescribed in 89% of HFrEF patients
• ARNi specifically accounted for 64% of prescriptions within the ACEi/ARB/ARNi category
• This reflects a preference for the more advanced neurohormonal blockade agent in this outpatient setting

Beta-blockers and SGLT2 inhibitors were prescribed at high rates in HFrEF patients after enrollment.

• Beta-blockers were prescribed in 97% of HFrEF patients
• SGLT2 inhibitors were prescribed in 85% of HFrEF patients
• MRA were also prescribed in 85% of HFrEF patients

Quadruple therapy was achieved in a majority of HFrEF patients, with rates varying depending on whether ARNi was included.

• Quadruple therapy including ARNi was prescribed in 69% of HFrEF cases
• Quadruple therapy without ARNi was prescribed in 51% of HFrEF cases
• This indicates that ARNi use contributed substantially to achieving quadruple therapy targets

The percentage of HFrEF patients receiving at least 50% of the recommended dose varied considerably across drug classes.

• 63% of patients received at least 50% of the recommended ARNi dose
• 41% of patients received at least 50% of the recommended ACEi/ARB dose
• 70% of patients received at least 50% of the recommended beta-blocker dose
• 98% of patients received at least 50% of the recommended MRA dose