Heart failure & cardiomyopathies
Therapy Gaps for Patients with Heart Failure and Reduced Kidney Function: A Prospective Cohort Study
Authors' conclusion
Gaps in HF therapy use persist in patients with comorbid kidney dysfunction.
Study context
- Population
- Patients with heart failure (HF) across the spectrum of kidney function and left ventricular ejection fraction (LVEF) (HFrEF, HFmrEF, HFpEF)
- Participants
- 1,401 patients
- Exposure
- HF therapy use across eGFR categories
- Outcome
- HF therapy use and dose intensity stratified by eGFR and HF type
- Follow-up
- Over 2 years
Methodological detailsobservational
- Observational
Main finding
As reported in the abstract
Baseline HF therapy use
ARNI
| Outcome | eGFR ≥60 | eGFR 30 to <60 | eGFR <30 |
|---|---|---|---|
| Beta-blocker | 95% | — not stated in the abstract | 88% |
| RASi | 94% | — not stated in the abstract | 68% |
| MRA | 75% | — not stated in the abstract | 35% |
| SGLT2 inhibitor | 15% | — not stated in the abstract | 7% |
| Guideline-directed dose RASi | 57% | 44% | — not stated in the abstract |
| Guideline-directed dose MRA | 26% | 19% | — not stated in the abstract |
— not stated in the abstract
Observational data: associations, not effects.
Further findings
Reasons for underutilizing renin-angiotensin system inhibitor (RASi) (eGFR <30)
- Kidney dysfunction the most frequently cited reason
All-cause mortality and hospitalization
- Higher all-cause mortality and hospitalization with eGFR <60
Safety
Hyperkalaemia (serum potassium > 5.5 mmol/L)
- Higher rates of hyperkalaemia with eGFR <60
Original publication
Therapy Gaps for Patients with Heart Failure and Reduced Kidney Function: A Prospective Cohort Study. ESC Heart Fail. Published 16 November 2025. doi:10.
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