Global Impact of Optimal Implementation of Guideline-Directed Medical Therapy in Heart Failure.

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JAMA cardiology Pub Date : 2024-12-01 DOI:10.1001/jamacardio.2024.3023

Amber B Tang, Boback Ziaeian, Javed Butler, Clyde W Yancy, Gregg C Fonarow

{"title":"Global Impact of Optimal Implementation of Guideline-Directed Medical Therapy in Heart Failure.","authors":"Amber B Tang, Boback Ziaeian, Javed Butler, Clyde W Yancy, Gregg C Fonarow","doi":"10.1001/jamacardio.2024.3023","DOIUrl":null,"url":null,"abstract":"Importance: Guideline-directed medical therapy (GDMT) remains underutilized on a global level, with significant disparities in access to treatment worldwide. The potential global benefits of quadruple therapy on patients with heart failure with reduced ejection fraction (HFrEF) have not yet been estimated.Objective: To assess the projected population-level benefit of optimal GDMT use globally among patients with HFrEF.Design, setting, and participants: Estimates for HFrEF prevalence, contraindications to GDMT, treatment rates, and the number needed to treat for all-cause mortality at 12 months were derived from previously published sources. Potential lives saved from optimal implementation of quadruple therapy among patients with HFrEF was calculated globally and a sensitivity analysis was conducted to account for uncertainty in the existing data.Main outcomes and measures: All-cause mortality.Results: Of an estimated 28.89 million people with HFrEF worldwide, there were 8 235 063 (95% CI, 6 296 020-10 762 972) potentially eligible for but not receiving β-blockers, 20 387 000 (95% CI, 15 867 004-26 184 996) eligible for but not receiving angiotensin receptor-neprilysin inhibitors, 12 223 700 (95% CI, 9 376 895-15 924 973) eligible for but not receiving mineralocorticoid receptor antagonists, and 21 229 170 (95% CI, 16 537 400-27 242 688) eligible for but not receiving sodium glucose cotransporter-2 inhibitors. Optimal implementation of quadruple GDMT could potentially prevent 1 188 277 (95% CI, 767 933-1 914 561) deaths over 12 months. A large proportion of deaths averted were projected in Southeast Asia, Eastern Mediterranean and Africa, and the Western Pacific regions.Conclusions and relevance: Improvement in use of GDMT could result in substantial mortality benefits on a global scale. Significant heterogeneity also exists across regions, which warrants additional study with interventions tailored to country-level differences for optimization of GDMT worldwide.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"1154-1158"},"PeriodicalIF":14.8000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447625/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamacardio.2024.3023","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Importance: Guideline-directed medical therapy (GDMT) remains underutilized on a global level, with significant disparities in access to treatment worldwide. The potential global benefits of quadruple therapy on patients with heart failure with reduced ejection fraction (HFrEF) have not yet been estimated.

Objective: To assess the projected population-level benefit of optimal GDMT use globally among patients with HFrEF.

Design, setting, and participants: Estimates for HFrEF prevalence, contraindications to GDMT, treatment rates, and the number needed to treat for all-cause mortality at 12 months were derived from previously published sources. Potential lives saved from optimal implementation of quadruple therapy among patients with HFrEF was calculated globally and a sensitivity analysis was conducted to account for uncertainty in the existing data.

Main outcomes and measures: All-cause mortality.

Results: Of an estimated 28.89 million people with HFrEF worldwide, there were 8 235 063 (95% CI, 6 296 020-10 762 972) potentially eligible for but not receiving β-blockers, 20 387 000 (95% CI, 15 867 004-26 184 996) eligible for but not receiving angiotensin receptor-neprilysin inhibitors, 12 223 700 (95% CI, 9 376 895-15 924 973) eligible for but not receiving mineralocorticoid receptor antagonists, and 21 229 170 (95% CI, 16 537 400-27 242 688) eligible for but not receiving sodium glucose cotransporter-2 inhibitors. Optimal implementation of quadruple GDMT could potentially prevent 1 188 277 (95% CI, 767 933-1 914 561) deaths over 12 months. A large proportion of deaths averted were projected in Southeast Asia, Eastern Mediterranean and Africa, and the Western Pacific regions.

Conclusions and relevance: Improvement in use of GDMT could result in substantial mortality benefits on a global scale. Significant heterogeneity also exists across regions, which warrants additional study with interventions tailored to country-level differences for optimization of GDMT worldwide.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

在心力衰竭患者中优化实施指导性医疗疗法的全球影响。

重要性：在全球范围内，指南指导下的医疗疗法（GDMT）仍未得到充分利用，全球范围内获得治疗的机会存在显著差异。四联疗法对射血分数降低型心力衰竭（HFrEF）患者的潜在全球益处尚未估算：目的：评估全球射血分数减低型心力衰竭患者最佳使用 GDMT 在人群层面的预计获益：HFrEF患病率、GDMT禁忌症、治疗率以及12个月内全因死亡率所需治疗人数的估计值均来自于之前发表的资料。对HFrEF患者最佳实施四联疗法可能挽救的生命进行了全球计算，并进行了敏感性分析，以考虑现有数据的不确定性：主要结果和测量指标：全因死亡率：结果：在约 28.结果：在全球约 2,890 万 HFrEF 患者中，有 8,235,063 人（95% CI，6,296,020-10,762,972）可能符合接受β受体阻滞剂治疗的条件，20,387,000 人（95% CI，15,867,004-26,184,996）符合接受血管紧张素受体-奈普利酶抑制剂治疗的条件，但未接受治疗、12 223 700 人（95% CI，9 376 895-15 924 973）符合条件但未接受矿质皮质激素受体拮抗剂治疗，以及 21 229 170 人（95% CI，16 537 400-27 242 688）符合条件但未接受钠葡萄糖共转运体-2 抑制剂治疗。最佳实施四联 GDMT 有可能在 12 个月内避免 1 188 277 例死亡（95% CI，767 933-1 914 561）。预计东南亚、东地中海和非洲以及西太平洋地区将避免大部分死亡：改进 GDMT 的使用可在全球范围内提高死亡率。各地区之间也存在显著的异质性，因此需要进行更多的研究，针对国家层面的差异采取干预措施，以在全球范围内优化 GDMT 的使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine

CiteScore

45.80

自引率

1.70%

发文量

264

期刊介绍： JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.

期刊最新文献

Trajectory of Cardiovascular Health Across Childhood and Adolescence Potassium Nitrate in Heart Failure With Preserved Ejection Fraction Chest Pain in a Middle-Aged Man Preventing Declines in Cardiovascular Health From Childhood: Never Too Early for Heart Health. Angiotensin Receptor-Neprilysin Inhibitor Prescribing Patterns in Patients Hospitalized for Heart Failure.