Abstract 18973: Regional Differences in Optimization of Medical Therapy for Heart Failure With Reduced Ejection Fraction: Data From the HF-OPT Trial (Heart Failure Optimization Trial)

Abstract

Background: Society guidelines for the optimization of guideline-directed medical therapy (GDMT) in patients with heart failure (HF) are almost identical between the United States (US) and Europe (EU). While GDMT has helped to improve survival and reduce HF hospitalization in this population, the initiation as well as titration to target doses shown to be safe and effective in clinical trials has been suboptimal. Purpose: The objective of this analysis was to assess regional differences in GDMT prescription in the United States (US) vs. Europe (EU) between 2017 and 2022.Methods: Medication data from patients (pts) with newly diagnosed heart failure with reduced ejection fraction (HFrEF) during wearable cardioverter-defibrillator use was collected from 487 pts (54% from US, 72% male, age 59±13 years). Target dose of GDMT was defined as the lowest maximum dose from either the ESC or ACC/AHA/HFSA guidelines. ACE-I/ARB/ARNI (AAA), beta blockers (BB), and mineralocorticoid receptor antagonists (MRA), were the main GDMT options for HFrEF patients at the time of HF-OPT. Association between medication with region and gender were assessed using logistic regression. Results: Compared to patients in the US, EU (Germany, Austria, France) pts were significantly more likely to receive ACE-I/ARB/ARNI and MRA and to achieve target doses by 90 and 180 days (p<0.01). Interestingly, ARNI prescription rates did not differ between US and EU (39% and 47%, p=0.09) by 180 days, although target doses were more likely to be reached in the EU by 180 days (23% vs. 12%, p<0.01). In contrast, rates of BB use and achieving target doses did not differ between regions (Figure). Finally, pts in the EU were more likely to receive all three medication classes by 180 days (80% vs 42%, p<0.001), and more likely to be prescribed target doses of all three medications (12% vs. 7%, p<0.05). After adjusting for region, there was no difference in gender for day 90 and 180 prescriptions and target doses for BB, AAA, and MRA.Conclusions: Adherence to GDMT was superior in the EU compared to the US with regards to ACE-I/ARB/ARNI and MRA. There was no difference in BB use between regions. Target dosage rates, however, were overall low in both regions.