A groundbreaking study led by researchers from UCLA has shed light on the critical role that guideline-directed medical therapy (GDMT) can play in reducing mortality rates for individuals suffering from heart failure with reduced ejection fraction (HFrEF) worldwide. The findings underscore the significant regional disparities that exist in the implementation of these life-saving interventions and the urgent need to address the barriers to their global adoption. Heart failure is a growing public health concern, and this research offers valuable insights into the potential to save millions of lives annually through the optimal use of GDMT.
The Missed Opportunity of GDMT
Heart failure (HF) is a complex disease that affects approximately 29 million individuals across the globe. Though there are evidence-based guidelines and the efficacy of GDMT care for improving outcomes has been established, it appears that many eligible individuals were not prescribed these life-saving medications.
The researchers believe that the findings pointed out to the vast disparities in GDMT incorporation in clinical practice, which leaves millions of patient with no opportunity to receive potentially life-saving interventions. For example, 8.2 million patients with HFrEF were not on beta-blockers, an additional 20.4 million were not receiving angiotensin receptor neprilysin inhibitors (ARNIs), 12.2 million were not being prescribed mineralocorticoid receptor antagonists (MRAs), and 21.2 million were missing out on sodium-glucose cotransporter-2 inhibitor (SGLT2) inhibitors from the treatment plan.
Lead study author Dr. Amber Tang highlighted the need to overcome damages of GDMT that included inadequate health literacy, access barriers and medication costs. “Despite all of that, there is massive underutilization of these guidelines in clinical practice worldwide and there are barriers to utilization,” she added.
Possibility of Saving Millions of Lives
Given no-compromise implementation of all GDMT could reduce global mortality rates in the high- and middle-income countries by around 75%, the analysis shows. They calculate that if these guidelines were universally adopted, it could avert 1.2 million deaths annually worldwide, most effectively in the Eastern Mediterranean, Southeast Asia and Western Pacific regions.
When you see these estimates of 5,000 to 10,000 lives saved a year through this rigorously designed analysis – that is just the kind of number that will highlight the scale of the problem and interest in getting therapies around the globe ASAP,” said principal study investigator Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center.
The results of the study illustrate, once again, the ongoing challenge to address regional disparities in GDMT use as well as demonstrate that potentially life-saving interventions should continue to be made available to all patients with heart failure irrespective of where they live or their socioeconomic position.
Global Scope of Heart Failure
This study underscores the increasingly impactful problem of heart failure as a worldwide health burden, with substantial heterogeneities in prevalence, management and prognosis between different regions.
“Significant regional variations exist for heart failure worldwide, and this study highlights that heart failure is not a single disease but one that is specific to the region or country in which it occurs,” said Dr. Fonarow, who wasn’t involved with the research.
It will take a collaborative effort among policymakers, healthcare providers and the community to address these health disparities. These strategies encompass enhancing the accessibility of healthcare, improving health literacy, as well as protecting the affordability of essential medications.
Collaboration between the medical community and global health organizations to tackle hurdles in GDMT implementation can potentially lead to millions of people with heart failure living longer, better lives across the world.
