Why the study?
Does optimal implementation of quadruple guideline-directed medical therapy reduce all-cause mortality in patients with HFrEF globally?
Does optimal implementation of quadruple guideline-directed medical therapy reduce all-cause mortality in patients with HFrEF globally?
Effect estimate: 1,188,277 deaths prevented (95% CI 767,933-1,914,561)
Optimal global implementation of quadruple guideline-directed medical therapy for HFrEF could prevent over 1.1 million deaths annually, highlighting a massive public health opportunity to close treatment gaps.
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 GDMT use globally among patients with HFrEF. Design, Setting, and Participants Estimates for HFrEF prevalence, contraindications to GDMT, 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 HFrEF 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 HFrEF worldwide, there were 8 235 063 (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 GDMT 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 GDMT 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 GDMT worldwide.
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Tang et al. (2024) studied Heart failure with reduced ejection fraction (HFrEF) (n=28,890,000). Optimal implementation of quadruple guideline-directed medical therapy (GDMT) vs. Current treatment rates was evaluated on All-cause mortality (1,188,277 deaths prevented, 95% CI 767,933-1,914,561). Optimal implementation of quadruple guideline-directed medical therapy globally could potentially prevent 1,188,277 deaths (95% CI, 767,933-1,914,561) over 12 months among patients with HFrEF.
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