Key result
Although most HFrEF patients received guideline-recommended medications, target dose achievement was low (13% for ACEI/ARB/ARNI), though higher when managed by heart failure specialists (40% vs 11%).
Why the study?
To describe the characteristics of ambulatory patients with HFrEF in the Gulf region and the implementation of guideline-recommended treatments.
What are the prescription rates and target dose achievement of guideline-recommended therapies for HFrEF outpatients in the Middle East?
Observational (n=2,427)
Yes
What are the prescription rates and target dose achievement of guideline-recommended therapies for HFrEF outpatients in the Middle East?
Absolute Event Rate: 40% vs 11%
p-value: p=<0.001
Despite high overall prescription rates of guideline-directed medical therapy for HFrEF in the Middle East, achievement of target doses remains severely suboptimal, particularly among older patients and those not managed by HF specialists.
Target dose achievement for HFrEF GDMT remains low outside specialist settings; leaves open whether dedicated HF clinics improve outcomes in the Middle East.
We describe the characteristics of ambulatory patients with heart failure with reduced ejection fraction (HFrEF) in the Gulf region (Middle East) and the implementation of guideline-recommended treatments. We included 2427 HFrEF outpatients (mean age 59 ± 13 years, 75% males and median left ventricular ejection fraction [LVEF] of 30%). A high proportion of patients received guideline-recommended medications (angiotensin-converting enzyme inhibitor [ACEI]/angiotensin receptor blocker [ARB]/angiotensin receptor-neprilysin inhibitor [ARNI] 87%, β-blocker 91%, mineralocorticoid antagonist [MRA] 64%). However, only a minority of patients received guideline-recommended target doses (ACEI/ARB/ARNI 13%, β-blocker 27%, and MRA 4.4%). Old age was a significant independent predictor for not prescribing treatment ( P < .001 for ACEI/ARB/ARNI and MRA; and P = .002 for β-blockers). Other independent predictors were chronic kidney disease (for both ACEI/ARB/ARNI and MRA, P < .001) and higher LVEF ( P = .014 for β-blockers and P < .001 for MRA). Patients with HFrEF managed by heart failure specialists more often received recommended target doses of ACEI/ARB/ARNI (40% vs 11%, P < .001) and β-blockers (56% vs 26%, P < .001) compared to those treated by general cardiologists. Although the majority of our patients with HFrEF received guideline-recommended medications, the doses they were prescribed were suboptimal. Understanding the reasons behind this is important for improved practice.
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Zubaid et al. (2020) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=2,427). Management by heart failure specialists vs. Management by general cardiologists was evaluated on Prescription of guideline-recommended target doses of ACEI/ARB/ARNI (p=<0.001). Although most HFrEF patients received guideline-recommended medications, target dose achievement was low (13% for ACEI/ARB/ARNI), though higher when managed by heart failure specialists (40% vs 11%).
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