Key result
Physician-led HF clinics linked to ~38-point increase in four-pillar GDMT use at 6 months.
Why the study?
Non-cardiologist physician-led HF clinics were established in Sarawak, Malaysia to improve GDMT uptake, motivating an evaluation of GDMT implementation and clinical outcomes in patients with HF with reduced ejection fraction across these clinics.
Does a protocolised, non-cardiologist physician-led heart failure clinic model improve guideline-directed medical therapy uptake, cardiac function, and clinical outcomes in adults with HFrEF in a resource-constrained setting?
Cohort (n=384)
Yes
Does a protocolised, non-cardiologist physician-led heart failure clinic model improve guideline-directed medical therapy uptake, cardiac function, and clinical outcomes in adults with HFrEF in a resource-constrained setting?
In a resource-constrained setting with limited cardiologist access, a protocolised non-cardiologist physician-led heart failure clinic model substantially increased four-pillar GDMT uptake and was associated with significant improvements in LVEF and NYHA functional class over 6 months.
May support non-cardiologist HF clinics for GDMT optimisation in resource-limited settings; leaves open outcome benefits versus usual care.
Background: In Sarawak, Malaysia, non-cardiologist physician-led heart failure (HF) clinics were established to improve uptake of guideline-directed medical therapy (GDMT). The objective of this study was to describe GDMT implementation and clinical outcomes in patients with HF with reduced ejection fraction managed in physician-led clinics across Sarawak. Methods: A multicentre, retrospective cohort of adults (aged ≥18 years) with HF with reduced ejection fraction (left ventricular ejection fraction ≤40%) was followed in physician-led HF clinics at nine hospitals (1 January 2021 to 30 June 2023). Demographics, comorbidities, symptoms, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide and GDMT use were collected at enrolment, 3 months (3M) and 6 months (6M). Outcomes were HF admission and all-cause mortality at 3M and 6M. Results: A total of 384 patients were enrolled (age 56.4 ± 13.7 years; 75.3% men). The comorbidity burden was high. Patients on three or more pillars of GDMT rose from 52% pre-clinic to 84% at 3–6M; use of four pillars increased from 12 to 49% at 6M. New York Heart Association class I increased from 26 to 60% by 6M. Among 150 patients with repeat echocardiography, left ventricular ejection fraction improved from 28.0 ± 7.6% to 39.7 ± 13.3%. N-terminal pro-B-type natriuretic peptide declined from 5,159 pg/ml (interquartile range 1,730–9,000) pre-clinic (n=19) to 611 (interquartile range 178–2,472) at 3M (n=30). By 3M, HF admission was 5.8% and mortality 4.2%; by 6M, HF admission was 7.7% and mortality was 10.4%. Conclusions: In a resource-constrained setting, a protocolised, physician-led clinic model achieved substantial GDMT uptake with improvements in symptoms alongside 3–6-month event rates comparable to other centres. These data support scaling pragmatic physician-led HF clinics to narrow evidence-to-practice gaps where specialist access is limited.
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Chew et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=384). Physician-led heart failure clinic management and GDMT optimization vs. Pre-clinic baseline status (single-arm cohort) was evaluated on Prescription of all four GDMT pillars at 6 months. Physician-led heart failure clinics increased four-pillar GDMT use from 11.5% to 49.2% at 6 months, with 7.7% HF admission and 10.4% all-cause mortality.
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