Delayed initiation of novel GDMTs associated with adverse outcomes in HF patients

Analysing the EVOLUTION-HF study, the initiation of treatment with novel guideline-directed medical therapies (GDMTs) for heart failure (HF), namely SGLT2 and ARN inhibitors, was delayed compared with that of pre-existing GDMTs in HF patients 1 year after HF hospitalisation (hHF). Additionally, these novel GDMTs tended to only be administered very late after the initial diagnosis of HF. These findings stress the need for earlier administration of the novel GDMTs.

Guidelines recommend that GDMTs should be initiated swiftly after the initial diagnosis of HF [1]. The multinational, observational EVOLUTION-HF study aimed to objectify patterns in patients with newly initiated GDMT treatment after HF hospitalisation [2]. In total, 194,181 patients were included from Japan, Sweden, and the USA, who had initiated treatment with at least one GDMT within 12 months of discharge after HF hospitalisation. Prof. Gianluigi Savarese (Karolinska University Hospital, Sweden) presented the results of the study.

The initiation of treatment with SGLT2 and ARN inhibitors was delayed compared with the initiation of MRAs, BBs, and RAAS inhibitors in the year after HF hospitalisation. Additionally, SGLT2 or ARN inhibitors were mostly prescribed to patients who were already following other GDMTs: at least 78% and 64% of the patients who started on SGLT2 or ARN inhibitors were already using BBs or RAAS inhibitors, respectively.

Furthermore, the administration of the novel GDMTs, SGLT2 inhibitors, or ARN inhibitors tended to occur late after the initial HF diagnosis, especially in patients with chronic kidney disease (CKD) or diabetes (see Figure).

Figure: Median time from first HF diagnosis to GDMT initiation after HF hospitalisation, according to subgroup [2]



“These results highlight the need for earlier use of the novel GDMTs in a large proportion of patients to reduce mortality and morbidity, as recommended by international guidelines,” concluded Prof. Savarese.

1. McDonagh TA, et al. Eur J Heart Fail. 2022;24(1):4–131.
2. Savarese G, et al. Delays in initiation of novel guideline-directed medical therapies following hospitalization for heart failure – insights from EVOLUTION HF, a multinational observational study. ePosters – focus on chronic heart failure 1, Heart Failure, 21–24 May, Madrid, Spain.

 

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Posted on 28 July 202228 July 2022