UCLA researchers predict following standard clinical guidelines can prevent 1.2 million deaths from heart failure worldwide


Summary: UCLA-led research underscores the underutilization of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) worldwide. Despite the potential of GDMT to save 1.2 million lives annually, many eligible patients do not receive life-saving treatments due to barriers like poor health literacy, limited access to care, and medication costs. The study, published in JAMA Cardiology, provides a global estimate of the mortality benefit of GDMT, with significant disparities in treatment implementation across different regions.

Key Takeaways:

  • Underuse of Life-Saving Therapies: Millions of patients with HFrEF who are eligible for treatments like beta blockers and SGLT2 inhibitors are not receiving them, leading to missed opportunities to save lives.
  • Global Mortality Impact: Proper implementation of GDMT could prevent 1.2 million deaths annually worldwide, with the greatest impact in regions like Southeast Asia and the Eastern Mediterranean.
  • Regional Disparities in Treatment: The study highlights significant differences in heart failure treatment access and implementation globally, influenced by socioeconomic and cultural factors.

Heart failure is a rapidly growing public health issue that can be difficult to manage on a global scale, but there are tools that exist that can improve outcomes, such as guideline-directed medical therapy (GDMT), the cornerstone of pharmacological therapy for patients with heart failure with reduced ejection fraction (HFrEF).

GDMT consists of the four main drug classes: renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid inhibitors, and sodium-glucose cotransporter 2 (SGLT-2) inhibitors. 

New UCLA-led research highlights the important role that these guidelines can play in reducing mortality rates for individuals with HFrEF.

“These guidelines are being significantly underutilized in clinical settings globally, and there are barriers that contribute to this, including poor health literacy, limited access to care, and medication costs,” says Amber Tang, MD, the lead author of the study and a medical resident at UCLA, in a release.

Many Patients Don’t Receive Life-Saving Treatment

The study, published in JAMA Cardiology, found that of the estimated 29 million people worldwide with HFrEF, many who were eligible to receive life-saving treatment did not receive treatment (8.2 million individuals for beta-blocker treatment; 20.4 million individuals for angiotensin receptor neprilysin inhibitors treatment; 12.2 million individuals for mineralocorticoid receptor antagonists treatment; and 21.2 million for SGLT2 inhibitors treatment), demonstrating the challenge in implementing these global guidelines.

However, with optimal implementation, researchers predict that the use of GDMT could prevent 1.2 million deaths per year worldwide, with more than 1 million lives saved in the Eastern Mediterranean, Southeast Asia, and Western Pacific.

Missed Opportunities

Researchers say the study, which examined existing patient data published from large registries to estimate heart failure prevalence, GDMT eligibility, current prescription rates, and potential lives saved across the world, is the first to estimate the mortality benefit of individuals with HFrEF globally, rather than just in the United States.

“There are significant regional disparities that exist across the world, and this study draws attention to the fact that heart failure is not a monolithic entity, but a condition that varies greatly based on socioeconomic and cultural nuances,” says Gregg Fonarow, MD, senior author of the study and director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of UCLA’s Preventative Cardiology Program, in a release.

Researchers say these findings highlight the significance of heart failure as a global health issue. “To see calculated projections of the potential number of lives saved each year allows the public and the medical community to see the magnitude of the problem and the urgency needed to bring therapeutic interventions to people around the world,” the researchers note.

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