4. What stage of your medical career you are currently at?
5. Settings of your practice(multiple choices allowed)
6. What is your medical specialty / sub-specialty?(single answer allowed)
7. For how many years have you been practicing?(type a whole number only)
8. How many patients with HF do you usually see per week?(type a whole number only)
HYPOTENSION EVALUATION
Please answer all questions
1. Below which systolic blood pressure (SBP) level do you consider a patient with HF to be hypotensive in routine clinical practice?
mm Hg
2. Do you apply different cut-offs for different HF phenotypes by left ventricular ejection fraction (EF)?
HF with EF <40%mm Hg
HF with EF ≥50%mm Hg
3. When evaluating a patient with hypotension, do you actively ask them for symptoms, or do you usually rely on their complaints?
4. Which of the symptoms do you consider to be the most attributable to symptomatic hypotension? (maximum 3 choices)
5. How frequently do you assess if hypotensive episodes and/or symptoms are related to:
Non-HF GDMT Drugs
Over-diuresis
Orthostasis
Meals
Physical activity
Myocardial ischemia
6. How sure are you that you know how to perform orthostatic testing?
7. How frequently do you perform active standing test in patients with heart failure?
At what occasion do you perform active standing test? (multiple choices allowed)
Select the most often used method of the active standing test?
8. How frequently do you use ambulatory blood pressure monitoring (ABPM) in patients with heart failure solely due to low blood pressure or hypotension?
9. What parameter(s) in ABPM report do you consider the most valuable in defining hypotension in a patient with heart failure? (multiple choices allowed)
Below which systolic blood pressure (SBP) level on ABPM would you consider a patient with HF to be hypotensive?mm Hg
EXPERIENCE
Please answer all questions
1. According to your experience, what proportion of your patients with heart failure have:
— hypotension based on office measurements
— orthostatic hypotension
— postprandial hypotension
2. What potential consequences of hypotension are you particularly worried about? (multiple choices allowed)
3. What are the main three factors on which you base your decision-making in a patient with HF and low blood pressure?
4. Please place a number after each GDMT class which reflects the sequence of drug initiation in a naïve patient with HF with ejection fraction <40% and low blood pressure (assuming heart rate is around 80 beats per minute)
ACEI / ARB / ARNI
BB
MRA
SGLT2i
5. For each of the classes provide the lowest SBP threshold below which you would NOT initiate the therapy in a naïve (for this class) patient with HF and ejection fraction <40%
ACEI/ARB
mm Hg
ARNI (in patients not on ACEi/ARB)
mm Hg
ARNI (in patients on ACEi/ARB)
mm Hg
BB
mm Hg
MRA
mm Hg
SGLT2i
mm Hg
6. When considering initiation of the following medications in a naïve (for this class) patient with HF with EF ≥50%, below which SBP threshold would you NOT initiate therapy?
SGLT2i
mm Hg
MRA
mm Hg
ACEI/ARB
mm Hg
ARNI (in patients not on ACEi/ARB)
mm Hg
ARNI (in patients on ACEi/ARB)
mm Hg
7. Do you use any non-pharmacological methods for the prevention of hypotension and its complications?
Please select all that apply (multiple choices allowed):
DECISION MAKING IN DIFFERENT CLINICAL SCENARIOS
Please answer all questions
1. A 60-year-old woman with non-ischemic cardiomyopathy and heart failure with reduced EF (28%) on stable GDMT for 6 months.
BP: 88/58 mmHg
HR: 64 bpm
eGFR: 70 mL/min/1.73 m² (no worsening), normal serum electrolytes
Symptoms: None (NYHA class I)
Signs: No clinical signs of congestion or hypovolemia
Please indicate how you would manage each of her current medications:
Sacubitril/valsartan 97/103 mg BID
Bisoprolol 5 mg OD
Dapagliflozin 10 mg OD
Spironolactone 25 mg OD
2. A 70-year-old man with type 2 diabetes mellitus, with adequate glycemic control on antidiabetic medications, prior myocardial infarction, and heart failure with reduced EF (32%), on stable therapy for 3 months.
BP: 100/60 mmHg
HR: 60 bpm (sinus rhythm)
eGFR: 47 mL/min/1.73 m² (3 months earlier – 58), normal serum electrolytes
Symptoms: dizziness on standing, fatigue (NYHA III)
Signs: No clinical signs of congestion or hypovolemia
Please indicate how you would manage each of his current medications:
Sacubitril/valsartan 97/103 mg BID
Carvedilol 25 mg BID
Empagliflozin 10 mg OD
Eplerenone 25 mg OD
Torsemide 10 mg
3. A 75-year-old woman with chronic heart failure with reduced EF (39%) and a history of atrial fibrillation (rate controlled) presents with lightheadedness on standing.
Supine BP and HR: 110/70 mmHg and 72 bpm
Standing BP and HR: 88/60 mmHg and 80 bpm
eGFR: 50 mL/min/1.73 m² (no worsening), normal serum electrolytes
Symptoms: Mild dizziness upon standing
Please indicate how you would manage each of her current medications: