Heart failure & cardiomyopathiesCohort study
Guideline-Directed Medical Therapy in Severe Heart Failure with Reduced Ejection Fraction: An Analysis from the HELP-HF Registry
- Registry-based cohort study
- multicentre
- consecutive patients
Authors' conclusion
In a large, real-world, contemporary cohort of patients with severe HFrEF, with at least one marker for advanced HF, prescription and uptitration of GDMT remained limited.
Study context
- Population
- Patients with HFrEF and at least one 'I NEED HELP' marker for advanced heart failure (HF)
- Participants
- 699 patients
- Exposure
- Guideline-directed medical therapy (GDMT) use, dosing and association with outcomes
Main finding
As reported in the abstract
GDMT prescription and dosing
- Beta-blockers (BB) administered
- 574 (82%)
- ACEi/ARB/ARNI administered
- 381 (55%)
- Mineralocorticoid receptor antagonists (MRA) administered
- 416 (60%)
- ≥50% of target dose reached, BB
- 41%
- ≥50% of target dose reached, ACEi/ARB/ARNI
- 22%
- ≥50% of target dose reached, MRA
- 56%
Observational data: associations, not effects.
Further findings
Death or HF hospitalisation
| Comparison | Estimate | |
|---|---|---|
| BB · treatment with BB | adjusted HR 0.63 (95% CI 0.48–0.84) | |
| ACEi/ARB/ARNI · treatment with ACEi/ARB/ARNI | HR 0.74 (95% CI 0.58–0.95) | |
| 0.512Ratio (log scale) |
Target doses not received for unknown causes
- BB
- 51%
- ACEi/ARB/ARNI
- 41%
- MRA
- 55%
- Main causes of underprescription/underdosing: hypotension, bradycardia, kidney dysfunction, hyperkalaemia
GDMT use in patients meeting 2018 HFA-ESC advanced HF criteria
- Lower proportions receiving BB and ACEi/ARB/ARNI
Original publication
Guideline-Directed Medical Therapy in Severe Heart Failure with Reduced Ejection Fraction: An Analysis from the HELP-HF Registry. Eur J Heart Fail. Published 22 November 2023. doi:10.1002/ejhf.3081
Summarised from the published abstract; every number is checked against it