Heart failure & cardiomyopathies
The impact of country income level on the management of heart failure with preserved ejection fraction: an international survey
Authors' conclusion
National income level is associated with major differences in diagnostic testing, medication access, specialist involvement, and multi-disciplinary care for HFpEF. These disparities highlight the need for scalable, resource-adapted strategies to optimize HFpEF care globally.
Study context
- Population
- Physicians managing heart failure with preserved ejection fraction (HFpEF), worldwidephysicians from 91 countries completed the survey (median age 42 years, 61% male)
- Participants
- 1,459 physicians
- Exposure
- Countries categorized according to the 2023 World Bank income classifications
- Outcome
- Type of clinician managing HFpEF
Methodological detailsinternational, distributed worldwide from May to July 2023
- International
- Distributed worldwide from May to July 2023
Main finding
As reported in the abstract
- Cardiologists more frequently involved in upper-middle-income countries (UMICs) and lower-middle-income countries (LMICs)/low-income countries (LICs) than high-income countries (HICs)
Observational data: associations, not effects.
Further findings
- Proportion of HFpEF among HF patients — HICs
- 40%
- Screening for coronary artery disease in new HFpEF cases — UMICs
- 40%
- Multi-disciplinary HF programmes — HICs
- 62%
- Proportion of HFpEF among HF patients: elsewhere 30%
- Proportion of HFpEF among HF patients: P < .001
- Screening for coronary artery disease in new HFpEF cases: LMICs/LICs 22%
- Multi-disciplinary HF programmes: LMICs/LICs 24%
- Multi-disciplinary HF programmes: P < .001
Use of natriuretic peptides and availability of echocardiographic parameters
- Use of natriuretic peptides varied significantly across settings, as did the availability of echocardiographic parameters, which was highest in HICs
Medication availability
- SGLT2 inhibitors widely available across all groups
- 88%
- Availability of ACE inhibitors, ARBs, MRAs, and loop diuretics showed clear income-related differences
Original publication
The impact of country income level on the management of heart failure with preserved ejection fraction: an international survey. ESC Heart Fail. Published 19 January 2026. doi:10.
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