Heart Failure: The Critical Role of Guideline Directed Medical Therapy

Wednesday, 2 October 2024, 08:11

Heart failure guidelines emphasize the importance of optimizing guideline-directed medical therapy (GDMT). Recent research suggests that implementing GDMT could prevent more than a million deaths from heart failure with reduced ejection fraction (HFrEF) annually. This potential is particularly significant in lower- and middle-income countries, where the burden of heart failure is increasing.
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Heart Failure: The Critical Role of Guideline Directed Medical Therapy

Impact of Guideline Directed Medical Therapy on Heart Failure

By optimizing the utilization of guideline-directed medical therapy (GDMT), doctors could prevent the deaths of more than a million patients with heart failure with reduced ejection fraction (HFrEF) per year.

New research published in JAMA Cardiology revealed a startling underutilization of quadruple GDMT across the globe. The researchers noted, “Although prior studies have estimated mortality benefits for individual components of GDMT, nearly all studies have focused on the US, the projected benefits of global optimization of GDMT remain unknown, despite lower- and middle-income countries experiencing increasing rates of heart failure.”

Global Implications and Current Utilization Rates

  • 8.2 million patients were potentially eligible for but not receiving β-blockers.
  • 20.4 million patients were eligible for but not receiving angiotensin receptor neprilysin inhibitors (ARNIs).
  • 2.2 million patients were eligible for but not receiving mineralocorticoid receptor antagonists (MRAs).
  • 21.2 million patients were eligible for but not receiving sodium glucose cotransporter-2 (SGLT2) inhibitors.

According to the researchers, optimal implementation of quadruple GDMT has the potential to prevent 1,188,277 (95% CI, 767,933-1,914,561) global deaths over 12 months, largely due to cardiovascular death prevention.

Contribution of Each Component to Lives Saved

Optimal utilization of ARNIs and SGLT2 inhibitors contributed the most to reducing deaths, accounting for 29.5% and 28.4% of lives saved, respectively. Optimal utilization of β-blockers led to 24.8% of total global lives saved, while MRAs were responsible for 17.4% of lives preserved worldwide.

Addressing Barriers to Implementation

Efforts toward reducing barriers to the administration of these beneficial drugs are necessary. This includes addressing social determinants of health, ensuring universal coverage for crucial therapies, and implementing treatments earlier.


This article was prepared using information from open sources in accordance with the principles of Ethical Policy. The editorial team is not responsible for absolute accuracy, as it relies on data from the sources referenced.


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