Table 1
Guideline-directed medical therapy for heart failure with reduced ejection fraction.
| LIST OF GUIDELINE-DIRECTED MEDICAL THERAPY FOR HEART FAILURE WITH REDUCED EJECTION FRACTION |
|---|
| Primary |
|
|
|
|
|
|
| Secondary |
|
|
|
|
|
[i] *Guideline-recommended from 2012.
**Guideline-recommended from 2016.
***Guideline-recommended from 2021.
Figure 1
PRISMA chart.
Figure 2
World map with countries and patients represented in the review.1
1The actual number of patients from each country can be found in Tables S8–S11.
Table 2
Study-level patient’s demographics and comorbidities by income setting and geographic region.
| STUDIES (PATIENTS) | FEMALE (%) | MEAN OR MEDIAN AGE | MEAN OR MEDIAN LVEF | HTN (%) | DM (%) | IHD/CAD (%) | AF (%) | CKD (%) | COPD (%) | CVA (%) | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OVERALL | ACUTE | NON-ACUTE | |||||||||||
| Total studies (population) | 334 (1,507,849) | 60 (278,210) | 274 (1,229,639) | 30.5 | 65.7 | 29.4 | 59.4 | 33.7 | 53.2 | 29.2 | 26.9 | 19.6 | 11.6 |
| Income status | |||||||||||||
| High-income | 272 (1,399,151) | 47 (258,165) | 226 (1,141,367) | 30.3 | 66.5 | 28.9 | 60.8 | 34.3 | 53.9 | 30.1 | 28.2 | 21.2 | 11.8 |
| LMIC | 45 (45,781) | 9 (8686) | 36 (37,095) | 33.1 | 61.8 | 32.0 | 52.0 | 29.0 | 47.9 | 23.6 | 21.8 | 11.5 | 12.1 |
| Upper-middle income | 37 (21,851) | 7 (7929) | 30 (13,922) | 32.6 | 62.9 | 31.6 | 54.7 | 29.6 | 50.8 | 26.9 | 24.3 | 11.8 | 14.7 |
| Lower-middle income | 6 (23,475) | 1 (610) | 6 (22865) | 28.7 | 58.3 | 34.0 | 50.2 | 36.6 | 45.7 | 10.8 | 16.2 | 9.1 | 4.2 |
| Low-income | 2 (455) | 1 (147) | 1 (308) | 55.5 | 52.6 | 40.4 | 27.4 | 9.1 | 33.1 | 21.3 | 5.5 | – | – |
| WHO regions | |||||||||||||
| Africa | 5 (1676) | 2 (757) | 3 (919) | 51.5 | 55.1 | 36.4 | 40.6 | 13.4 | 21.8 | 19.0 | 10.0 | 2.8 | 6.5 |
| Americas | 111 (1,091,008) | 24 (183,731) | 87 (907,277) | 34.4 | 65.6 | 27.5 | 66.7 | 38.6 | 55.6 | 30.2 | 26.4 | 27.4 | 12.6 |
| E. Mediterranean | 6 (5063) | 2 (787) | 4 (4276) | 21.9 | 59.5 | 32.4 | 62.9 | 60.1 | 61.5 | 12.5 | 14.3 | 11.2 | 6.8 |
| Europe | 151 (293,235) | 15 (67,263) | 141 (237,659) | 27.2 | 66.5 | 30.1 | 57.6 | 29.1 | 54.2 | 30.1 | 32.2 | 17.6 | 11.0 |
| South-East Asia | 10 (31,093) | 3 (5401) | 7 (25,692) | 33.2 | 63.6 | 28.8 | 48.9 | 35.8 | 45.2 | 15.9 | 15.2 | 8.0 | 6.9 |
| Western Pacific | 32 (22,147) | 11 (9613) | 21 (12,534) | 31.9 | 67.0 | 31.4 | 50.0 | 32.2 | 47.0 | 31.3 | 30.8 | 11.1 | 14.7 |
[i] Studies involving data from multiple income groups not included.
LMIC: low- and middle-income; AF: atrial fibrillation; LVEF: left ventricular ejection fraction; HTN: hypertension; IHD/CAD: ischemic heart disease/coronary artery disease; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; CVA: cardiovascular accident; DM: diabetes mellitus; E. Mediterranean: Eastern Mediterranean.
Figure 3
Prevalence of use of GDMT by WHO regions.
Figure 4
Prevalence of GDMT use by income status.
Figure 5
Meta-regression bubble plots for the association between study-year1 and prevalence of use of (a) β-blockers; (b) Renin–angiotensin system (RAS) inhibitors; (c) mineralocorticoid receptor antagonists (MRAs) and (d) diuretics use. Effect estimates and 95% confidence intervals (CI) are adjusted for country income level.
1Study-year was defined as end-date of data collection.