At 12 months follow-up, only 19% of patients with de novo heart failure with reduced ejection fraction achieved target doses of beta-blockers and 6% achieved target doses of ACEi/ARBs.
Cohort (n=48)
No
What are the rates of utilization and achievement of target doses of GDMT in patients with de novo HFrEF, and what are the reasons for underutilization?
In patients with de novo HFrEF, the achievement of target doses of GDMT remains suboptimal at 1 year, primarily limited by patient factors like hypotension and renal dysfunction, highlighting the need for concerted efforts to improve up-titration.
BACKGROUND: The utilization of guideline-directed medical therapy (GDMT) significantly reduces morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF). Previous studies have documented the underutilization of GDMT in HFrEF. The present study aimed to determine reasons for underutilization and achievement of target doses of GDMT in patients with de novo diagnosis of HFrEF. METHODS: Patients presenting with de novo HFrEF at the Veterans Affairs Medical Center were included. Baseline demographic, clinical, and echocardiographic data were collected. The utilization of target doses of GDMT was assessed at the time of discharge and 1-, 3-, 6-, and 12-month follow-up. RESULTS: Of the 95 patients who met the criteria for de novo HFrEF, 48 were included in the final analysis. Dose titration of either beta-blocker or angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) was attempted in 20 patients (42%) at 1 month, 21 patients (44%) at 3 months, 13 patients (27%) at 6 months, and 14 patients (29%) at 12 months. Nine (19%) patients were on a target dose of beta-blockers and three (6%) patients were on a target dose of an ACEi/ARB at 12 months. The most common reasons for underutilization were patient-level factors, such as hypotension, acute kidney injury/hyperkalemia, and patient noncompliance. CONCLUSIONS: Utilization and achievement of target doses of GDMT were suboptimal among patients discharged with de novo HFrEF during a 1-year follow-up. Although patient factors may limit the up-titration of therapies, concerted efforts are needed to support primary care physicians in improving adherence to target doses of GDMT in patients with HFrEF.
Dasari et al. (Wed,) conducted a cohort in de novo heart failure with reduced ejection fraction (HFrEF) (n=48). Guideline-directed medical therapy (GDMT) was evaluated on Achievement of target doses of beta-blockers and ACEi/ARBs at 12 months. At 12 months follow-up, only 19% of patients with de novo heart failure with reduced ejection fraction achieved target doses of beta-blockers and 6% achieved target doses of ACEi/ARBs.