Trends in guideline-directed medical therapy and clinical outcomes in Taiwanese heart failure patients: insight from the TSOC HF registry 2020

Background Current guidelines recommend an early and intensive treatment strategy for patients with heart failure (HF). However, limited data exist regarding the real-world implementation of guideline-directed medical therapy (GDMT) across different HF phenotypes and its impact on clinical outcomes. Purpose The Taiwan Society of Cardiology (TSOC) HF Registry 2020 aimed to evaluate temporal trends in the prescription of GDMT and its association with prognosis among Taiwanese HF patients. Methods This prospective, multicenter, observational study enrolled 2,782 HF patients from 27 hospitals in Taiwan between 2020 and 2022, with a minimum follow-up period of two years. Eligible patients included those admitted for acute decompensated HF or outpatients with a history of HF hospitalization within the preceding six months. Prescription rates of renin-angiotensin system inhibitors, angiotensin receptor neprilysin inhibitors (ARNIs), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), sodium-glucose co-transporter 2 inhibitors (SGLT2is), and ivabradine were assessed from 2020 to 2024. Cardiovascular mortality rates and HF readmission frequencies were collected and analyzed based on the year of enrollment. Results Figure 1 illustrates the temporal trends in prescription rates for GDMT. Among patients with HF with reduced ejection fraction, prescription rates of ARNIs, BBs, MRAs, and SGLT2is significantly increased from 2020 to 2024 (ARNI: 36% to 59%, p<0.001; BB: 79% to 84%, p=0.001; MRA: 61% to 68%, p<0.001; SGLT2i: 12% to 65%, p<0.001), while ivabradine prescription remained stable at approximately 22% (p=0.12). Among patients with HF with mildly reduced or preserved ejection fraction, the prescription rates of ARNIs, MRAs, and SGLT2is significantly increased from 2020 to 2024 (ARNI: 10% to 15%, p=0.009; MRA: 45% to 52%, p<0.001; SGLT2i: 8% to 38%, p<0.001), while BB and ivabradine prescription rates remained relatively unchanged over time. Cardiovascular mortality rates decreased from 5.72 per 100 patient-years among patients enrolled in 2020 to 5.46 and 5.36 per 100 patient-years among those enrolled in 2021 and 2022, respectively. Additionally, HF readmission rates declined over time (2020: 20.86 per 100 patient-years; 2021: 18.4 per 100 patient-years; 2022: 17.81 per 100 patient-years). Conclusions The findings from the TSOC HF Registry 2020 highlight a significant increase in the adoption of GDMT over time. These changes were associated with a decline in cardiovascular mortality and HF readmissions, emphasizing the importance of adherence to guideline-directed therapies in improving patient outcomes. Continued efforts are needed to further optimize HF management and ensure widespread implementation of evidence-based treatments.