National Impact of Optimal Implementation of Guideline-Directed Medical Therapy in Heart Failure With Reduced Ejection Fraction.
Optimal guideline-directed therapy implementation could prevent 113,747 heart failure deaths annually.
National Impact of Optimal Implementation of Guideline-Directed Medical Therapy in Heart Failure With Reduced Ejection Fraction.
Despite robust evidence that quadruple guideline-directed medical therapy (guideline-directed medical therapy), comprising angiotensin receptor-neprilysin inhibitors (angiotensin receptor-neprilysin inhibitors), evidence-based beta-blockers, mineralocorticoid receptor antagonists (mineralocorticoid receptor antagonists), and sodium-glucose cotransporter 2 (SGLT2) inhibitors, reduces mortality and hospitalizations in heart failure with reduced ejection fraction (HFrEF), implementation in clinical practice remains markedly incomplete.
This study aimed to provide updated national estimates of the eligible untreated HFrEF population and to quantify deaths and hospitalizations preventable with optimal implementation of quadruple guideline-directed medical therapy in the United States.
Trial-derived numbers needed to treat and relative risk reductions were applied to estimate deaths preventable over 12 months and annual heart failure (heart failure) hospitalizations prevented.
An estimated 2.76 million U.
S. adults with chronic symptomatic HFrEF were eligible for quadruple guideline-directed medical therapy, yet only 18.2% received it.
Eligible untreated populations included 733,891 for beta-blockers, 1,856,531 for angiotensin receptor-neprilysin inhibitors, 1,543,967 for mineralocorticoid receptor antagonists, and 1,717,444 for SGLT2 inhibitors.
Optimal implementation was also projected to prevent 357,332 heart failure hospitalizations annually (95% UI: 297,493-425,674).
Incomplete implementation of quadruple guideline-directed medical therapy in HFrEF remains a major modifiable opportunity to reduce preventable deaths and heart failure hospitalizations in the United States.