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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Mortality and guideline-directed medical therapy in real-world heart failure patients with reduced ejection fraction

Peter A McCullough1, Hirsch S Mehta2, Colin M Barker3

  • 1Texas A & M College of Medicine, Dallas, Texas, USA.

Clinical Cardiology
|August 3, 2021
PubMed

Insights

Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is underutilized. Patients not receiving GDMT face a 29% higher mortality risk, underscoring the importance of optimal treatment.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Heart failure with reduced ejection fraction (HFrEF) is a significant cause of morbidity and mortality.
  • Guideline-directed medical therapy (GDMT) has been proven to reduce mortality in HFrEF patients.
  • Real-world data on GDMT prevalence and its impact on mortality in HFrEF is crucial for clinical practice improvement.

Purpose of the Study:

  • To determine the prevalence of guideline-directed medical therapy (GDMT) in US patients with heart failure with reduced ejection fraction (HFrEF).
  • To evaluate the association between GDMT and all-cause mortality in HFrEF patients.
  • To identify potential gaps in GDMT implementation in a real-world setting.

Main Methods:

  • Retrospective cohort study using the Optum Integrated File (2007-2019Q3).
  • Identified adult patients with a history of HFrEF.
  • Defined GDMT as prescription fills for a beta-blocker plus an ACE inhibitor, ARB, or ARNI within 6 months post-diagnosis. Assessed 2-year all-cause mortality using Cox regression.

Main Results:

  • The study included 14,880 HFrEF patients; 70% received GDMT, and 57% had concurrent medication fills.
  • Patients not on GDMT exhibited a 29% increased risk of all-cause mortality compared to those on GDMT (HR 1.29; 95% CI [1.19-1.40]; p < .0001).
  • A sensitivity analysis showed a 37% increased mortality risk for patients not on GDMT compared to those on concurrent GDMT medication fills.

Conclusions:

  • Inadequate guideline-directed medical therapy (GDMT) is associated with a significant excess mortality risk in real-world HFrEF populations.
  • A substantial proportion of HFrEF patients are not receiving optimal GDMT, highlighting a critical gap in care.
  • Adherence to GDMT is essential for improving survival outcomes in patients with heart failure with reduced ejection fraction.
Abstract

Keywords:
goal directed medical therapyheart failure with reduced ejection fractionmortalityreal-world evidence

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