The involvement of cardiologists in managing HFpEF was significantly higher in upper-middle-income and lower-middle-income countries than in high-income countries.
How does national income level influence the global variation in the diagnosis and management of heart failure with preserved ejection fraction (HFpEF)?
National income level significantly impacts the diagnosis, medication access, and multidisciplinary care available for patients with HFpEF globally.
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Abstract Aim To assess how national income level influences global variation in the diagnosis and management of heart failure with preserved ejection fraction (HFpEF). Methods A web-based survey on HFpEF diagnosis and treatment was distributed worldwide from May to July 2023 through email, scientific societies, and social networks. Respondents provided demographic information and details on diagnostic practices, resource availability, and treatment approaches. Countries were categorized according to the 2023 World Bank income classifications: high-income (HICs), upper-middle-income (UMICs), lower-middle-income (LMICs), and low-income (LICs). Results 1,459 physicians from 91 countries completed the survey (median age 42 years; 61% male). Income level influenced the type of clinician managing HFpEF, with cardiologists more frequently involved in UMICs and LMICs/LICs than HICs. Respondents in HICs reported a higher proportion of HFpEF among their HF patients (40% vs 30% elsewhere; p0.001). Use of natriuretic peptides varied significantly across settings, as did the availability of echocardiographic parameters required for HFpEF assessment, which was highest in HICs. Screening for coronary artery disease in new HFpEF cases ranged from 22% in LMICs/LICs to 40% in UMICs. Availability of ACE inhibitors, ARBs, MRAs, and loop diuretics showed clear income-related differences, while SGLT2 inhibitors were widely available across all groups (88%). Multidisciplinary HF programs were most common in HICs (62%) and least common in LMICs/LICs (24%; p0.001). Conclusions National income level is associated with major differences in diagnostic testing, medication access, specialist involvement, and multidisciplinary care for HFpEF. These disparities highlight the need for scalable, resource-adapted strategies to optimize HFpEF care globally.
Ingimarsdóttir et al. (Sat,) reported a other. The involvement of cardiologists in managing HFpEF was significantly higher in upper-middle-income and lower-middle-income countries than in high-income countries.