Real-World Use of Guideline-Directed Therapy for Heart Failure: Insights From the Danish Heart Failure Registry

Schjødt, I; Valentin, JB; Johnsen, SP; Mols, RE; Egstrup, K; Løgstrup, BB

doi:10.1002/ehf2.15320

Heart failure & cardiomyopathies

Real-World Use of Guideline-Directed Therapy for Heart Failure: Insights From the Danish Heart Failure Registry

ESC Heart FailPublished 11 May 2025Registry study

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Authors' conclusion

We demonstrated high use of RASi and beta-blockers and rising use of MRA and SGLT2i, reflecting rapid adaption to guidelines changes in incident HFrEF patients. Early GDMT initiation was associated with lower 1 and 3 year mortality and all-cause hospitalization. Upfront treatment with GDMT, according to the latest guidelines, is crucial.

Study context

Population: Incident HFrEF patients in the Danish Heart Failure Registry, 2008–2022
Participants: 46,816 incident HFrEF patients

Exposure: Guideline-directed medical therapy (GDMTs) [none, 1-2 GDMTs, and 3-4 GDMTs] initiated at 4, 8 and 12 weeks
Outcome: All-cause mortality (GDMT initiation at 4 weeks)
Follow-up: 1 year

Methodological detailsDanish Heart Failure Registry, Cox regression, adjusted hazard ratios

Danish Heart Failure Registry
Cox regression
Adjusted hazard ratios

Main finding

As reported in the abstract

Each group vs noneAdjusted hazard ratio (95% CI)

1-2 GDMTs

0.73(0.61–0.86)

3-4 GDMTs

0.65(0.55–0.78)

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk vs none ←→ Higher risk vs none →	Adjusted HR (95% CI)
All-cause mortality (GDMT initiation at 4 weeks) · 3 year1-2 GDMTsvs none	0.512	0.75 (0.66–0.86)
All-cause mortality (GDMT initiation at 4 weeks) · 3 year3-4 GDMTsvs none	0.512	0.67 (0.59–0.76)
Cardiovascular mortality (GDMT initiation at 4 weeks) · 3 year1-2 GDMTsvs none	0.512	0.74 (0.62–0.89)
Cardiovascular mortality (GDMT initiation at 4 weeks) · 3 year3-4 GDMTsvs none	0.512	0.72 (0.59–0.87)
All-cause hospitalization (GDMT initiation at 4 weeks) · 1 year1-2 GDMTsvs none	0.512	0.80 (0.75–0.86)
All-cause hospitalization (GDMT initiation at 4 weeks) · 1 year3-4 GDMTsvs none	0.512	0.78 (0.73–0.84)
All-cause hospitalization (GDMT initiation at 4 weeks) · 3 year1-2 GDMTsvs none	0.512	0.77 (0.72–0.83)
All-cause hospitalization (GDMT initiation at 4 weeks) · 3 year3-4 GDMTsvs none	0.512	0.77 (0.71–0.82)
	0.512Adjusted hazard ratio (log scale)

RASi utilization, 2008-2011 vs 2021-2022 · 4 and 12 weeks of follow-up

4 weeks, 2008-2011: 93.2%
4 weeks, 2021-2022: 93.7%
12 weeks, 2008-2011: 97.2%
12 weeks, 2021-2022: 97.8%

Beta-blocker use, 2008-2011 vs 2021-2022 · 4 and 12 weeks of follow-up

4 weeks, 2008-2011: 81.1%
4 weeks, 2021-2022: 78.2%
12 weeks, 2008-2011: 89.6%
12 weeks, 2021-2022: 90.4%

MRA utilization, 2008-2011 vs 2021-2022 · 4 and 12 weeks of follow-up

4 weeks, 2008-2011: 27.2%
4 weeks, 2021-2022: 34.6%
12 weeks, 2008-2011: 32.6%
12 weeks, 2021-2022: 52.2%

SGLT2i use, 2016-2020 vs 2021-2022 · 4 and 12 weeks of follow-up

4 weeks, 2016-2020: 0.0%
4 weeks, 2021-2022: 21.3%
12 weeks, 2016-2020: 3.2%
12 weeks, 2021-2022: 35.8%

Original publication

Real-World Use of Guideline-Directed Therapy for Heart Failure: Insights From the Danish Heart Failure Registry. ESC Heart Fail. Published 11 May 2025. doi:10.1002/ehf2.15320

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