No phenotype-based differences in discharge GDMT across the LVEF spectrum in acute heart failure: data from multicenter registry
S Azhgaliyeva, V Medovchshikov, N Yeshniyazov, G Aryspayeva, Z H Lepessova, Z H Oralbekova, A Baizhanova, E Suieugaziyeva, M Balabayeva, G Yussupova, Z H Iskakova, D Murzagaliyeva, B Duisenbayev, G Kurmanalina, B ZholdinAbstract
Background
Current clinical guidelines recommend evidence-based therapy (GDMT) for heart failure (HF) across the full spectrum of left ventricular ejection fraction (LVEF). However, regional data on phenotype-specific discharge GDMT prescription remain scarce.
Purpose
To compare prescription rates of evidence-based HF therapy among patients with different echocardiographic HF phenotypes in West Kazakhstan.
Methods
A retrospective multicenter registry included 427 patients hospitalized with acute heart failure (AHF), including de novo AHF and decompensation of chronic HF, across five centers in four regions of West Kazakhstan. Patients were classified as HF with preserved (HFpEF, ≥50%), mildly reduced (HFmrEF, 41-49%), or reduced ejection fraction (HFrEF, ≤40%). Prescription rates of RAS inhibitors (ACE inhibitors/ARBs/ARNI), beta-blockers, MRAs, and SGLT2 inhibitors at discharge were compared across HF phenotypes.
Results
The median age was 66 (59; 75) years, and 40.2% of patients were women. HFrEF was diagnosed in 54.1% of patients, HFmrEF in 32.1%, and HFpEF in 13.8%. Significant differences in baseline characteristics were observed (Fig.1). Ischemic etiology of HF was more prevalent in HFmrEF/HFrEF, whereas non-ischemic etiology was more common in HFpEF. Patients with HFpEF were older, more frequently female, and had a higher prevalence of hypertension, whereas prior myocardial infarction was more common in HFmrEF and HFrEF. Atrial fibrillation was common across phenotypes, while cardiomyopathy was more frequent in HFrEF than in HFpEF and HFmrEF. Additional baseline characteristics are detailed in Fig.1.
Despite these differences, prescription rates of GDMT did not differ significantly between phenotypes. RAS inhibitors were prescribed in 94.7% of HFpEF, 91.7% of HFmrEF, and 88.8% of HFrEF patients (p=0.340). Beta-blockers were prescribed in 94.7%, 97.0%, and 93.8%, respectively (p=0.401). MRAs were prescribed in 91.2%, 82.0%, and 84.3% (p=0.268), while SGLT2 inhibitors were prescribed in 82.5%, 82.0%, and 88.8% of patients (p=0.153).
Conclusions
Discharge prescription rates of major GDMT classes were high and did not differ across HFpEF, HFmrEF, and HFrEF despite marked differences in demographics, comorbidity burden, and etiology. This pattern may reflect comorbidity-driven prescribing or protocolized discharge pathways rather than phenotype-tailored decision-making, thereby highlighting the need to assess appropriateness beyond a simple "yes/no" prescription by accounting for target dosing, contraindications, and phenotype-specific indications. The high prescription rate of SGLT2 inhibitors may reflect initiation during the index hospitalization.Figure 1 For image description, please refer to the figure legend and surrounding text.