Heart failure & cardiomyopathiesCohort study
Heart failure with reduced ejection fraction in Sweden: patient adherence and persistence to quadruple pharmacotherapy prescription
- Registry-based cohort study
- nationwide registry
- pharmacy refill data
Authors' conclusion
By 2023, use of quadruple therapy reached ∼60%, being mostly limited by lower adoption of MRA (∼73%). Patient adherence to foundational therapies was high and appeared associated with better prognosis.
Study context
- Population
- Patients with Heart Failure with Reduced Ejection Fraction (HFrEF) in the Swedish Heart Failure Registry, January 2016 – December 2023
- Participants
- 35,215 patients
- Outcome
- Use of, adherence (≥80% proportion of days covered) and persistence (dispensations at 12 ± 2 months) to quadruple HFrEF therapy; association with HF hospitalisation/CV death
Main finding
As reported in the abstract
Use, adherence and persistence to foundational HFrEF therapies
- Use in 2023: beta-blockers
- 93%
- Use in 2023: Renin-angiotensin-system inhibitors (RASi)/angiotensin receptor-neprilysin inhibitors (ARNi)
- 95%
- Use in 2023: Mineralocorticoid receptor antagonists (MRA)
- 73%
- Use in 2023: SGLT2i
- 83%
- Use in 2023: quadruple therapy
- 60%
- Adherent / persistent: beta-blockers
- 95% / 90%
- Adherent / persistent: RASi/ARNi
- 95% / 89%
- Adherent / persistent: MRA
- 90% / 77%
- Adherent / persistent: SGLT2i
- 94% / 86%
- Adherent / persistent: quadruple therapy
- 85% / 67%
Observational data: associations, not effects.
Further findings
HF hospitalisation/CV death
- Good adherence and persistence for beta-blockers, RASi/ARNi and MRA, and good adherence for SGLT2i, independently associated with lower HF hospitalisation/CV death
Original publication
Heart failure with reduced ejection fraction in Sweden: patient adherence and persistence to quadruple pharmacotherapy prescription. Eur Heart J. Published 1 April 2026. doi:10.1093/eurheartj/ehag199
Summarised from the published abstract; every number is checked against it