Pharmacotherapy treatment patterns at hospital discharge and clinical outcomes among patients with heart failure with reduced ejection fraction

Background:This study aimed to assess the prescribing patterns of evidencebased pharmacotherapy and their association with clinical outcomes in patients with heart failure with reduced ejection fraction(HFrEF)in Thailand.Methods:A retrospective cohort study of patients with HFrEF was conducted.Treatment with aβ-blocker and renin-angiotensin system inhibitors(RASIs)with or without mineralocorticoid receptor antagonists(MRAs)at discharge was regarded as guideline-directed medical therapy(GDMT).All others were considered non-GDMT.The primary endpoint was the composite of all-cause mortality or heart failure(HF)rehospitalization.Inverse-probabilitytreatment-weighted adjusted Cox proportional hazard models were used to examine the treatment effects.Results:In total,653 patients with HFrEF(mean age 64.1±14.3 years;55.9%male)were included.GDMT withβ-blockers and RASIs with or without MRAs was prescribed at a rate of 35.4%.During a median of 1-year follow-up,167 patients(27.5%)had a composite event,81 patients(13.3%)had all-cause mortality,and 109 patients(18.0%)had HF rehospitalization.Patients treated with GDMT at discharge showed significantly lower rates of the primary endpoint(adjusted hazard ratio[HR]0.63;95%CI 0.44-0.89;p=0.009)compared with patients who did not receive GDMT.The use of GDMT was also associated with a significantly lower risk of all-cause mortality(adjusted HR 0.59;95%CI 0.36-0.98;p=0.045)and HF rehospitalization(adjusted HR 0.65;95%CI 0.43-0.96;p=0.031).Conclusions:For HFrEF treatment,GDMT initiation at hospital discharge was associated with a significantly reduced risk of all-cause mortality and HF rehospitalization.Nevertheless,prescribing GDMT remains underused,and it could be encouraged to improve HF outcomes in real-world settings.