Global Impact of Optimal Implementation of Guideline-Directed Medical Therapy in Heart Failure

Global Impact of Optimal Implementation of Guideline-Directed Medical Therapy in Heart Failure JAMA Cardiol . 2024 Dec 1;9(12):1154-1158. doi: 10.1001/jamacardio.2024.3023.  Abstract Importance: Guideline-directed medical therapy (GDMT) remains underutilized on a global level, with significant disparities in access to treatment worldwide. The potential global benefits of quadruple therapy on patients with heart failure with reduced ejection fraction (HFrEF) have not yet been estimated.  Objective: To assess the projected population-level benefit of optimal Guideline-directed medical therapy use globally among patients with heart failure with reduced ejection fraction.  Design, setting, and participants: Estimates for heart failure with reduced ejection fraction prevalence, contraindications to Guideline-directed medical therapy, treatment rates, and the number needed to treat for all-cause mortality at 12 months were derived from previously published sources. Potential lives saved from optimal implementation of quadruple therapy among patients with heart failure with reduced ejection fraction was calculated globally and a sensitivity analysis was conducted to account for uncertainty in the existing data.  Main outcomes and measures: All-cause mortality.  Results: Of an estimated 28.89 million people with heart failure with reduced ejection fraction worldwide, there were 8 2,35 063 (95% CI, 6 296 020-10 762 972) potentially eligible for but not receiving β-blockers, 20, 387 000  (95% CI, 15 867 004-26 184 996) eligible for but not receiving angiotensin receptor-neprilysin inhibitors, 12 223 700  (95% CI, 9 376 895-15 924 973) eligible for but not receiving mineralocorticoid receptor antagonists, and 21 229 170  (95% CI, 16 537 400-27 242 688) eligible for but not receiving sodium glucose cotransporter-2 inhibitors. Optimal implementation of quadruple Guideline-directed medical therapy could potentially prevent 1 188 277 (95% CI, 767 933-1 914 561) deaths over 12 months. A large proportion of deaths averted were projected in Southeast Asia, Eastern Mediterranean and Africa, and the Western Pacific regions.  Conclusions and relevance: Improvement in use of Guideline-directed medical therapy could result in substantial mortality benefits on a global scale. Significant heterogeneity also exists across regions, which warrants additional study with interventions tailored to country-level differences for optimization of Guideline-directed medical therapy worldwide. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.