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. 2022 May;27(3):741-753.
doi: 10.1007/s10741-021-10077-x. Epub 2021 Jan 20.

Factors associated with non-use and sub-target dosing of medical therapy for heart failure with reduced ejection fraction

Stephen J Greene  1   2 , Xi Tan  3 , Yu-Chen Yeh  4 , Mark Bernauer  4 , Omer Zaidi  4 , Mei Yang  3 , Javed Butler  5
Affiliations

Factors associated with non-use and sub-target dosing of medical therapy for heart failure with reduced ejection fraction

Stephen J Greene et al. Heart Fail Rev. 2022 May.

Abstract

In clinical practice, many patients with heart failure with reduced ejection fraction (HFrEF) are either not prescribed guideline-directed medical therapies for which they are eligible or are prescribed therapies at sub-target doses. The objective of this study was to examine the factors associated with not receiving guideline-directed medical therapies or receiving sub-target doses. We conducted a systematic review of articles published between January 2014 and May 2019 that described dosing patterns and factors associated with non-use and sub-target dosing of HFrEF therapies in clinical practice. Thirty-seven studies were included. The percentages of patients reaching target doses for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, sacubitril/valsartan, beta-blockers, and mineralocorticoid receptor antagonists ranged from 4 to 55%, 11 to 87%, 4 to 60%, and 22 to 80%, respectively. Older age and worsening renal function were associated with non-use and sub-target dosing, lower body mass index was commonly associated with non-use, and hyperkalemia and hypotension were commonly associated with sub-target dosing. In conclusion, several common patient characteristics are associated with non-use and sub-target dosing of medical therapy for HFrEF. These high-risk groups are in particular need of further studies to improve implementation of available medications and to define the role of novel therapies.

Keywords: Drug therapy; Guideline adherence; Heart failure; Maximum tolerated dose; Systolic heart failure.

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