ImportanceGuideline-directed medical therapy (GDMT) remains underutilized on a global level, with significant disparities in access to treatment worldwide. The potential global benefits of quadruple therapy on patients with heart failure with reduced ejection fraction (HFrEF) have not yet been estimated.ObjectiveTo assess the projected population-level benefit of optimal GDMT use globally among patients with HFrEF.Design, Setting, and ParticipantsEstimates for HFrEF prevalence, contraindications to GDMT, treatment rates, and the number needed to treat for all-cause mortality at 12 months were derived from previously published sources. Potential lives saved from optimal implementation of quadruple therapy among patients with HFrEF was calculated globally and a sensitivity analysis was conducted to account for uncertainty in the existing data.Main Outcomes and MeasuresAll-cause mortality.ResultsOf an estimated 28.89 million people with HFrEF worldwide, there were 8 235 063 (95% CI, 6 296 020-10 762 972) potentially eligible for but not receiving β-blockers, 20 387 000 (95% CI, 15 867 004-26 184 996) eligible for but not receiving angiotensin receptor–neprilysin inhibitors, 12 223 700 (95% CI, 9 376 895-15 924 973) eligible for but not receiving mineralocorticoid receptor antagonists, and 21 229 170 (95% CI, 16 537 400-27 242 688) eligible for but not receiving sodium glucose cotransporter-2 inhibitors. Optimal implementation of quadruple GDMT could potentially prevent 1 188 277 (95% CI, 767 933-1 914 561) deaths over 12 months. A large proportion of deaths averted were projected in Southeast Asia, Eastern Mediterranean and Africa, and the Western Pacific regions.Conclusions and RelevanceImprovement in use of GDMT could result in substantial mortality benefits on a global scale. Significant heterogeneity also exists across regions, which warrants additional study with interventions tailored to country-level differences for optimization of GDMT worldwide.

中文翻译：

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心力衰竭中指南指导性药物治疗最佳实施的全球影响


重要性指南导向的药物治疗 （GDMT） 在全球范围内仍未得到充分利用，全球获得治疗的机会存在显著差异。尚未估计四联疗法对射血分数降低的心力衰竭 （HFrEF） 患者的潜在整体益处。目的评估全球最佳 GDMT 使用在 HFrEF.Design、环境和参与者患者中的预计人群水平益处HFrEF 患病率估计、GDMT 禁忌症、治疗率和 12 个月时全因死亡率需要治疗的人数来自先前发表的来源。在全球范围内计算了 HFrEF 患者最佳实施四联治疗可能挽救的生命，并进行了敏感性分析以解释现有数据的不确定性。主要结局和措施全因死亡率。结果在全球估计的 2889 万 HFrEF 患者中，有 8 235 063 人（95% CI，6 296 020-10 762 972）可能符合条件但未接受β阻滞剂，20 387 000 人（95% CI，15 867 004-26 184 996）符合条件但未接受血管紧张素受体-脑啡肽酶抑制剂，12 223 700 人（95% CI，9 376 895-15 924 973）符合条件但未接受盐皮质激素受体拮抗剂， 和 21 229 170 （95% CI， 16 537 400-27 242 688） 符合条件但未接受钠葡萄糖协同转运蛋白 2 抑制剂。四重 GDMT 的最佳实施可能会在 12 个月内防止 1 188 277 （95% CI， 767 933-1 914 561） 死亡。预计东南亚、东地中海和非洲以及西太平洋地区避免了很大一部分死亡。结论和相关性GDMT 使用的改进可能会在全球范围内带来巨大的死亡率益处。各地区也存在显著的异质性，因此需要根据国家层面的差异进行额外的研究，以优化全球 GDMT。