Patient factors associated with titration of medical therapy in patients with heart failure with reduced ejection fraction: data from the QUALIFY international registry

Abstract

Aims: Failure to prescribe key medicines at evidence-based doses is associated with increased mortality and hospitalization forpatients with Heart Failure with reduced Ejection Fraction (HFrEF). We assessed titration patterns of guideline-recommendedHFrEF medicines internationally and explored associations with patient characteristics in the global, prospective, observational,longitudinal registry. Methods and results: Data were collected from September 2013 through December 2014, with 7095 patients from 36 coun-tries [>18 years, previous HF hospitalization within 1–15 months, left ventricular ejection fraction (LVEF)≤40%] enrolled, withdosage data at baseline and up to 18 months from 4368 patients. In 4368 patients (mean age 63 ± 17 years, 75% male)≥100%target doses at baseline: 30.6% (ACEIs), 2.9% (ARBs), 13.9% (BBs), 53.8% (MRAs), 26.2% (ivabradine). Atfinal follow-up,≥100%target doses achieved in more patients for ACEI (34.8%), BB (18.0%), and ivabradine (30.5%) but unchanged for ARBs (3.2%)and MRAs (53.7%). Adjusting for baseline dosage, uptitration during follow-up was more likely with younger age, highersystolic blood pressure, and in absence of chronic kidney disease or diabetes for ACEIs/ARBs; younger age, higher body massindex, higher heart rate, lower LVEF, and absence of coronary artery disease for BBs. For ivabradine, uptitration was morelikely with higher resting heart rate. Conclusions: The international QUALIFY Registry suggests that few patients with HFrEF achieve target doses ofdisease-modifying medication, especially older patients and those with co-morbidity. Quality improvement initiatives are ur-gently required.