Temporal trends and prognostic impact of comprehensive guideline-directed medical therapy in HFrEF: a 1-year follow-up from the KorHF III registry
S Kim, B S Yoo, J W SonAbstract
Background/Introduction
Comprehensive guideline-directed medical therapy (GDMT) improves survival in heart failure with reduced ejection fraction (HFrEF). However, real-world implementation and its longitudinal impact on outcomes remain incompletely characterized.
Purpose
This study evaluated temporal trends in GDMT implementation and their association with 1-year clinical outcomes using a large-scale nationwide registry
Methods
We analyzed patients with HFrEF (left ventricular ejection fraction [LVEF] ≤40%) enrolled in the KorHF III registry. Prescription patterns of four foundational pillars—renin-angiotensin system (RAS) inhibitors, beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors (SGLT2i)—were assessed at discharge and at 1, 3, 6, and 12 months. Patients were categorized by the number of combined therapies. The primary outcomes were all-cause death and HF re-admission at 1 year.
Results
Among 4,010 patients (age, 65.8 years; 65.7% male; mean LVEF 27.1%), discharge prescription rates were 83.5% for RAS inhibitors, 77.3% for BB, 67.1% for MRA, and 20.8% for SGLT2i. RAS inhibitors and BB prescriptions remained stable, whereas MRA use declined significantly to 54.1% and SGLT2i use increased to 25.7% at 12 months (P for trend<0.001 for both). Over 12 months, MRA use significantly declined to 54.1%, while SGLT2i use increased to 25.7% (both P for trend <0.001). Notably, the proportion of patients receiving triple or quadruple therapy decreased from 55.3% to 50.7% (P for trend = 0.002), whereas those on no therapy increased from 3.3% to 8.1% (P for trend<0.001). Patients receiving triple or more therapies had significantly lower risk of all-cause death (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.59-0.87; P<0.001) and HF re-admission (HR, 0.85; 95% CI, 0.72-1.00; P = 0.049) compared with those receiving ≤2 agents.
Conclusion
Comprehensive GDMT was associated with significantly improved 1-year survival and reduced HF readmission in HFrEF. Nevertheless, substantial underutilization and treatment de-escalation were observed over time, highlighting a persistent implementation gap in real-world practice.Table.Cox analysis