Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool; Global Centre for Preventive Health, Institute for Health Transformation, Deakin University, Geelong
Fisaha Tesfay
Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool
Rashmi Pant
The George Institute for Global Health, Hyderabad
Ehete Bahiru
Department of Cardiology, University of Washington, Seattle, Washington
Claudia Bambs
Department of Public Health, Advanced Center for Chronic Diseases (ACCDiS, Fondap 15130011) and Center for Cancer Prevention and Control (CECAN, Fondap 152220002), School of Medicine, Pontificia Universidad Católica de Chile, Santiago
Anubha Agarwal
Cardiovascular Division, Washington University School of Medicine in St. Louis, St. Louis, Missouri
Sanne A. E. Peters
The George Institute for Global Health, University of New South Wales, Sydney, AU; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, NL; The George Institute for Global Health, School of Public Health, Imperial College London, London
Abdul Salam
The George Institute for Global Health, Hyderabad, IN; The George Institute for Global Health, University of New South Wales, Sydney, AU; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal
Division of Cardiology, Department of Medicine K2, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, SE; Population Health Research Institute, McMaster University, Hamilton
Optimal use of guideline-directed medical therapy (GDMT) can prevent hospitalization and mortality among patients with heart failure (HF). We aimed to assess the prevalence of GDMT use for HF across geographic regions and country-income levels. We systematically reviewed observational studies (published between January 2010 and October 2020) involving patients with HF with reduced ejection fraction. We conducted random-effects meta-analyses to obtain summary estimates. We included 334 studies comprising 1,507,849 patients (31% female). The majority (82%) of studies were from high-income countries, with Europe (45%) and the Americas (33%) being the most represented regions, and Africa (1%) being the least. Overall prevalence of GDMT use was 80% (95% CI 78%–81%) for β-blockers, 82% (80%–83%) for renin–angiotensin-system inhibitors, and 41% (39%–43%) for mineralocorticoid receptor antagonists. We observed an exponential increase in GDMT use over time after adjusting for country-income levels (p < 0.0001), but significant gaps persist in low- and middle-income countries. Multi-level interventions are needed to address health-system, provider, and patient-level barriers to GDMT use.
