Characteristics and Outcomes of Heart Failure Patients from a Middle-Income Country: The RECOLFACA Registry

Guideline-directed medical therapy for heart failure: Real-world evidence in one Latin-American center

BACKGROUND

Despite recommendations from clinical practice guidelines to initiate four drug classes in patients with heart failure (HF) with reduced ejection fraction, information on real-world implementation remains limited. This study evaluated the medications initiated and titrated, the time until the optimal treatment tolerated, pharmacological profiles, patient's adherence, and causes of non-use of guideline directed-medical therapy (GDMT) in a cohort of patients with HF.

METHODS

A retrospective cohort study was conducted on patients treated in a heart failure program in Colombia. Optimal treatment tolerated was defined as that achieved within 6 months of follow-up. Medication adherence was assessed using the 4-item Morisky-Green scale.

RESULTS

A total of 471 patients were included, with a median age of 76 years, 56.9 % male, and a median left ventricular ejection fraction of 35 %. Overall, 43.9 % of patients were on GDMT quadruple therapy, with a median time to optimal tolerated treatment of 57 days (IQR: 1-133). More than 90 % reached target doses with mineralocorticoid receptor antagonists and SGLT2 inhibitors, while less than 50 % achieved it with beta-blockers and renin-angiotensin-aldosterone system inhibitors. Adherence, according to the Morisky-Green scale, was 89.9 % and main causes of non-adherence were lack of social-family support (46.8 %) and forgetting to take medication (44.7 %).

CONCLUSIONS

In this real-world study of patients with HF, GDMT use rates were higher than those previous national registries. However, the medication doses were lower than those recommended by clinical guidelines. Identifying and quantifying adherence barriers in low- or middle-income countries is essential for implementing recommendations in clinical practice.

Characteristics, treatment and prognosis of patients with chronic heart failure according to ejection fraction. Results of an Ecuadorian registry

BACKGROUND

In Ecuador, there are few data about the clinical behaviour of heart failure (HF). This study aims to analyse the clinical characteristics, treatment and prognosis according to the current classification based on left ventricular ejection fraction (EF).

METHODS

A retrospective observational study was carried out in patients with chronic HF from the 'Los Ceibos' registry during the period January 2017-December 2022. Patients were classified into HF with preserved EF (HFpEF) [EF ≥ 50%], HF with mildly reduced EF (HFmrEF) [EF:41-49%], and HF with reduced (HFrEF) [EF ≤ 40%]. The patients were followed up for a mean time of 2.28 (IQR 1.25-3.49) years.

RESULTS

A total of 711 patients were included, 333 (46.8%) with HFrEF, 109 patients (15.3%) with HFmrEF and 269 patients (37.8%) with HFpEF. The average age was 69.8 ± 13.1 years, 31.4% were women. The main comorbidity was arterial hypertension (92.7%). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were used in 74.5%, beta-blockers in 82.3%, and mineralocorticoid receptor antagonists in 51.3%. 58.3% of patients with HFrEF received three drugs of the so-called foundational quadruple therapy. A lower all-cause (24.5%) and cardiovascular mortality rate (11,2%) was observed in the HFpEF group compared to HFmrEF (47.4% and 25,7%) and HFrEF (45.3% and 25,8%), p < 0.001.

CONCLUSIONS

In the 'Los Ceibos' registry, a higher prevalence of HFrEF was observed. The main comorbidity was HTN. Half of the patients with HFrEF received three drugs of the foundational therapy. At four years of follow-up, lower all-cause and cardiovascular mortality rate was observed in the HFpEF group.

Heart failure, the global pandemic: A call to action consensus statement from the global presidential conclave at the platinum jubilee conference of cardiological society of India 2023

Heart failure (HF) is emerging as a major public health problem both in high- and low - income countries. The mortality and morbidity due to HF is substantially higher in low-middle income countries (LMICs). Accessibility, availability and affordability issues affect the guideline directed therapy implementation in HF care in those countries. This call to action urges all those concerned to initiate preventive strategies as early as possible, so that we can reduce HF-related morbidity and mortality. The most important step is to have better prevention and treatment strategies for diseases such as hypertension, ischemic heart disease (IHD), type-2 diabetes, and rheumatic heart disease (RHD) which predispose to the development of HF. Setting up dedicated HF-clinics manned by HF Nurses, can help in streamlining HF care. Subsidized in-patient care, financial assistance for device therapy, use of generic medicines (including polypill strategy) will be helpful, along with the use of digital technologies.

What Do We Know About Heart Failure in Latin American Women?

Data about heart failure in Latin America is scarce. Women living in this region of the world are exposed to a mix of traditional risk factors for heart failure, neglected diseases, and social determinants of health. The aim of this review is to present what we know about heart failure in Latin American women and to establish the needs for future research.