Physician adherence and patient-reported outcomes in heart failure with reduced ejection fraction in the era of angiotensin receptor-neprilysin inhibitor therapy

Abstract

This Korean nationwide, multicenter, noninterventional, prospective cohort study aimed to analyze physician adherence to guideline-recommended therapy for heart failure (HF) with reduced ejection fraction (HFrEF) and its effect on patient-reported outcomes (PROs). Patients diagnosed with or hospitalized for HFrEF within the previous year were enrolled. Treatment adherence was considered optimal when all 3 categories of guideline-recommended medications (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors; beta-blockers; and mineralocorticoid receptor antagonists) were prescribed and suboptimal when ≤ 2 categories were prescribed. The 36-Item Short Form Survey (SF-36) scores were compared at baseline and 6 months between the 2 groups. Overall, 854 patients from 30 hospitals were included. At baseline, the optimal adherence group comprised 527 patients (61.7%), whereas during follow-up, the optimal and suboptimal adherence groups comprised 462 (54.1%) and 281 (32.9%) patients, respectively. Patients in the suboptimal adherence group were older, with a lower body mass index, and increased comorbidities, including renal dysfunction. SF-36 scores were significantly higher in the optimal adherence group for most domains (P < 0.05). This study showed satisfactory physician adherence to contemporary treatment for HFrEF. Optimal adherence to HF medication significantly correlated with better PROs.

Figure 1

Schematic summary of the study design. ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor; BB, beta-blocker; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; ICD-10, International Classification of Diseases 10th Revision; MRA, mineralocorticoid receptor antagonist; NYHA, New York Heart Association; SF-36, 36-Item Short Form Survey. *I50, I50.0, I50.1, I50.9, I11.0, I13.0, I13.2, I25.5, I42, I42.x.

Figure 2

Treatment patterns of guideline-recommended medications at baseline. ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor; BB, beta-blocker; HF, heart failure; MRA, mineralocorticoid receptor antagonist. *Indicates the percentage of patients who were prescribed only 1 category of HF medication.

Figure 3

Comparison of SF-36 scores according to physician adherence at baseline and at the 6-month follow-up. MCS, mental component summary; NS, not significant; PCS, physical component summary; SF-36, 36-Item Short Form Survey.

Figure 4

Comparison of physician adherence in this study with previous heart failure registry studies. ARNI, angiotensin receptor-neprilysin inhibitor; BB, beta-blocker; MRA, mineralocorticoid receptor antagonist; RASi, renin–angiotensin–aldosterone system inhibitor.