Overall prevalence of guideline-directed medical therapy use for heart failure was 80% for β-blockers, 82% for renin–angiotensin-system inhibitors, and 41% for mineralocorticoid receptor antagonists.
What is the global prevalence of guideline-directed medical therapy use among patients with heart failure with reduced ejection fraction across different country-income levels?
Despite exponential increases in GDMT use over time, significant gaps in the prescription of guideline-directed medical therapy for HFrEF persist globally, particularly for mineralocorticoid receptor antagonists and in low- and middle-income countries.
Optimal use of guideline-directed medical therapy (GDMT) can prevent hospitalization and mortality among patients with heart failure (HF). We aimed to assess the prevalence of GDMT use for HF across geographic regions and country-income levels. We systematically reviewed observational studies (published between January 2010 and October 2020) involving patients with HF with reduced ejection fraction. We conducted random-effects meta-analyses to obtain summary estimates. We included 334 studies comprising 1,507,849 patients (31% female). The majority (82%) of studies were from high-income countries, with Europe (45%) and the Americas (33%) being the most represented regions, and Africa (1%) being the least. Overall prevalence of GDMT use was 80% (95% CI 78%–81%) for β-blockers, 82% (80%–83%) for renin–angiotensin-system inhibitors, and 41% (39%–43%) for mineralocorticoid receptor antagonists. We observed an exponential increase in GDMT use over time after adjusting for country-income levels (p < 0.0001), but significant gaps persist in low- and middle-income countries. Multi-level interventions are needed to address health-system, provider, and patient-level barriers to GDMT use.
Satheesh et al. (2024) studied this question. Overall prevalence of guideline-directed medical therapy use for heart failure was 80% for β-blockers, 82% for renin–angiotensin-system inhibitors, and 41% for mineralocorticoid receptor antagonists.