Current state of medication treatment practice for heart failure with reduced ejection fraction among cardiologists in Japan: a survey on the relationship between satisfaction levels and adherence to guideline-directed medical therapy

BACKGROUND: The number of patients with heart failure is steadily increasing in parallel with the aging of the population in Japan. This study aimed to assess the level of satisfaction with the latest treatments, identify the factors influencing satisfaction, and investigate the current guideline-directed medical therapy (GDMT) practice for heart failure with reduced ejection fraction (HFrEF) among cardiologists in Japan. METHODS: Respondents were categorised into two groups based on their level of satisfaction with the current treatment for HFrEF. Those who responded "(1) Not satisfied," "(2) Somewhat dissatisfied," or "(3) Neither satisfied nor dissatisfied" encompassed the dissatisfied group. Conversely, those who responded "(4) Somewhat satisfied" or "(5) Satisfied" comprised the satisfied group. RESULTS: A total of 203 valid responses were collected from cardiologists in Japan in a survey conducted between December 27, 2023, and January 30, 2024. These respondents were divided into two groups based on their satisfaction with the current HFrEF treatment: those who were dissatisfied (n = 92) and those who were satisfied (n = 111). The demographics of the respondents in the two groups revealed no differences. However, the dissatisfied group reported a significantly higher proportion of patients under their care who were considered refractory to treatment than the satisfied group (p = 0.015). Although the dissatisfied group was more likely to indicate that patients' heart failure (HF) underlying characteristics influenced their treatment more (4.15 vs. 3.90, p = 0.045), the satisfied group was significantly more likely to indicate that domestic (4.38 vs. 4.13, p = 0.021) and international (3.85 vs. 3.60, p = 0.039) guidelines influenced their HF treatment practices. Sodium-glucose transport protein 2 (SGLT2) inhibitor prescription related to increased satisfaction (odds ratio, 2.199; 95% confidence interval, 1.102-4.392; p = 0.025). CONCLUSION: Approximately 50% of the respondents were dissatisfied with the current pharmacological treatment of patients with chronic HFrEF, suggesting that SGLT2 inhibitors were prescribed less frequently and that patient management tended to be guided more by individual symptoms and underlying HF characteristics rather than strict adherence to GDMT. The use of SGLT2 inhibitors was significantly associated with higher treatment satisfaction, particularly among physicians who adhered more closely to current GDMT recommendations.