Guideline-directed medical and device therapy in heart failure: insights from the ESC heart failure iii registry in Armenia
L Sahakyan, H Hayrapetyan, L Tumasyan, T Manukyan, A Chilingaryan, H Poghosyan, M Hovhannisyan, L Tunyan, G Martirosyan, S Pepoyan, K Azaryan, M Tadevosyan, L Melikyan, H SisakyanAbstract
Background
Guideline-directed medical therapy (GDMT) and device therapy improve outcomes in heart failure (HF). Real-world implementation varies across healthcare systems and is influenced by drug availability and reimbursement policies. National data from the European Society of Cardiology (ESC) Heart Failure (HF) III Registry allow assessment of these differences in Armenia.
Purpose
To evaluate the real-world use of guideline-directed pharmacological therapy, adjunctive cardiovascular medications, and device therapy among HF patients enrolled in the ESC HF III Registry in Armenia.
Methods
We retrospectively analyzed 190 in-hospital patients enrolled in the ESC HF III Registry across four hospitals in Armenia between 1 November 2018 and 31 December 2020. Baseline demographic, clinical, and treatment data were collected. GDMT included ACEi/ARB/ARNI, beta-blockers, and mineralocorticoid receptor antagonists (MRA). SGLT2 inhibitors were not completely captured due to lack of national registration at that timeline. Adjunctive therapies included oral and intravenous diuretics, ivabradine, and digitalis. Device therapy (ICD, CRT) was assessed in guideline-eligible patients. Treatment utilization is reported as percentages of eligible patients.
Results
The cohort had a mean age of 64±11 years, 35% women; HFrEF was present in 70%. Among eligible patients, ACEi/ARB/ARNI were prescribed in 59%, beta-blockers in 64%, and MRA in 55%. Oral diuretics were used in 62%, intravenous diuretics in 69%. Ivabradine and digitalis were prescribed in 2.6% and 8.3%, respectively. ICD and CRT implantation rates among eligible patients were 17% and 7%.
Conclusion
This national ESC HF III Registry analysis demonstrates real-world patterns of in-hospital pharmacological and device therapy in HF, revealing suboptimal treatment particularly related to device implementation. These findings highlight important opportunities to improve evidence-based therapies and optimize HF care at a national level.