Key result
Recent consensus guidelines show minimal impact as GDMT prescription remains <2% in Australian HFrEF patients.
Why the study?
GDMT uptake for HFrEF is suboptimal, prompting a 2022 Australian Consensus Statement advocating a four-pillar regimen, but its impact on primary care prescribing trends remained unknown.
Does the publication of a local HF Consensus Statement improve the prescription and target dose achievement of guideline-directed medical therapy in Australian primary care patients with HFrEF?
Does the publication of a local HF Consensus Statement improve the prescription and target dose achievement of guideline-directed medical therapy in Australian primary care patients with HFrEF?
Guideline-directed medical therapy for HFrEF remains severely underutilized in Australian primary care, with less than 2% of patients receiving four-pillar therapy and notable disparities affecting women and older individuals.
Answers are grounded in this paper and cite their sources.
GDMT remains severely underused with disparities in Australian primary care HFrEF; confirms suboptimal uptake and leaves open effective implementation strategies.
Background/introduction Uptake of guideline directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is suboptimal. Given the lack of contemporary local guidelines, a HF Consensus Statement was published in 2022 which aimed to espouse the importance of a four-pillar regimen and to provide a local lens on implementing evidence-based therapies. Purpose We aimed to describe the characteristics of Australian HFrEF patients in the primary care setting and to evaluate the impact of the Consensus Statement on temporal prescribing trends. Methods Data from patients ≥18 years old with a HF diagnosis or ≥2 HF medication prescriptions between 1 January 2018 to 31 December 2023 were extracted from IQVIA GP-EMR, a database covering de-identified electronic medical records of ~300 Australian general practices. A US-based algorithm was adapted and validated to probabilistically identify patients by HFpEF or HFrEF class (positive predictive value 0.953 (0.842,0.994)). HFrEF treatment patterns were described overall and by diabetes status, sex and age. Results 14992 patients were identified; 8470 with HFrEF, 6522 with HFpEF. HFrEF patients were younger (73.2 vs. 77.3 years, p<0.001) and more commonly male (66.1 vs. 40.0%, p<0.001). GDMT was suboptimal and, excepting SGLT-2i, demonstrated minimal change following the consensus statement (figure). Four pillar GDMT was prescribed in <2%. Target dose achievement varied: ACE/ARB, 42%; ARNi, 7%; beta blocker 26%; MRA, 17% and SGLT-2i, 100%. SGLT-2i use was more common in those with vs. without diabetes (14.1 vs. 1.4%) and patients aged < vs. ≥75 years (5.3 vs. 2.7%). Compared to men, women were less likely to receive SGLT-2i (2.6 vs. 4.9%) and ARNi (3.0 vs. 5.8%). Conclusion GDMT for HFrEF remains suboptimal with minimal change observed since the introduction of the Australian consensus statement and differentially among women and older individuals. Greater efforts at bridging the implementation gap are required.
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Nelson et al. (2025) studied this question. GDMT was prescribed in <2% of Australian HFrEF patients, with 100% SGLT-2i target dose, but minimal improvement post-2022 Consensus, lower use in women and elderly.
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