A recent report published in JAMA Cardiology suggests that better use of guideline-directed medical therapy (GDMT) for heart failure could drastically lower global mortality rates. The study estimates that improved implementation of GDMT could prevent approximately 1.19 million deaths each year worldwide, with over a million lives saved in regions such as the Eastern Mediterranean, Africa, Southeast Asia, and the Western Pacific.
“This study underscores the significant benefits of optimizing GDMT quadruple therapy at a global level,” said Dr. Gregg C. Fonarow, the lead investigator from UCLA’s division of cardiology. The research team emphasized that understanding regional differences can enhance global heart failure management strategies.
Despite the proven effectiveness of GDMT in improving outcomes and reducing mortality, its use remains low worldwide.
Previous studies have primarily focused on the U.S., leaving the potential benefits of global GDMT optimization for heart failure with reduced ejection fraction (HFrEF) largely unexamined.
Dr. Fonarow and his colleagues aimed to assess the benefits of optimal GDMT use among a global population with HFrEF.
They based their estimates on heart failure prevalence data from the Global Burden of Disease study and applied findings from U.S. registries to a worldwide context.
The analysis revealed that around 29 million people globally suffer from HFrEF. Of these, approximately 8.2 million are eligible for but not receiving beta-blockers, while about 12.2 million are not receiving angiotensin receptor-neprilysin inhibitors (ACEI/ARB). Additionally, around 12.2 million individuals are eligible for mineralocorticoid receptor antagonists (MRA), and 21.2 million for sodium-glucose cotransporter-2 (SGLT2) inhibitors.
The study found that optimal implementation of quadruple GDMT therapy could save an estimated 1,188,277 lives within a year, especially by preventing cardiovascular deaths. The most substantial benefits were observed in Southeast Asia and the Western Pacific, where around 720,054 deaths could be averted.
The researchers noted that angiotensin receptor-neprilysin inhibitors (ARNIs) and SGLT2 inhibitors account for the largest share of lives saved—29.5% and 28.4%, respectively. In comparison, optimal use of beta-blockers could save about 24.8% of lives, while MRAs could contribute to 17.4% of total lives saved globally.
The findings highlight that many individuals with HFrEF live in regions with low treatment rates, suggesting significant room for improvement in GDMT utilization worldwide.
“Future studies should explore the variations within regions and identify targeted interventions,” the authors concluded.
“This research emphasizes the urgent need for improved implementation of GDMT therapies globally.”
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