Use of Guideline-Directed Medical Therapy in Patients Aged ≥ 65 Years After the Diagnosis of Heart Failure: A Canadian Population-Based Study

Figures

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  Figure 1. Study flow diagram. HF, heart failure; HFrEF, HF with reduced ejection fraction; non HFrEF, HF without reduced ejection fraction. Territories includes the Northwest Territories, Nunavut and Yukon.

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  Figure 2. Pharmacotherapy achieved by patients with heart failure (HF) and those with HF with reduced ejection fraction (HFrEF) by 6 months post index discharge.

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  Figure 3. Categorization of patients with heart failure (HF) by proportion of maximum (max) guideline-directed medical therapy intensity score achieved. Intensity scores were calculated for each patient by starting with either the dose from the last day of therapy or the maximum therapy dose within 6 months post index, and then dividing by the maximum achievable intensity score. HFrEF, heart failure with reduced ejection fraction.

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  Figure 4. Average proportion of maximum guideline-directed medical therapy (GDMT) intensity score for patients with heart failure with reduced ejection fraction (HFrEF) calculated daily over 6 months post index discharge. Each data point is the average intensity score with 95% confidence interval for all patients with HFrEF (black, n = 66,372) or patients with HFrEF on triple therapy (TT; red, n = 13,508) divided by the maximum achievable Intensity score.

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  Figure 5. Trend of guideline-directed medical therapy (GDMT) between 2013 and 2018. Black: proportion of patients on triple therapy at any dose each fiscal year (%). Red: proportion of patients on optimum GDMT each fiscal year. Optimum GDMT defined as receiving ≥ 50% of the target dose for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, ≥ 50% of the target dose for beta blocker, and any dose of mineralocorticoid receptor antangonist. CI, confidence interval.