Treatment gaps in guideline-directed medical therapy for HFrEF in Singapore: findings from a multicentre retrospective cohort study - PubMed
5 hours ago
- #Heart Failure
- #Singapore
- #Guideline Adherence
- Study focuses on treatment gaps in guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) in Singapore.
- Retrospective cohort study involving 3999 adults across seven public hospitals from 2020 to 2022.
- Only 29% of eligible patients received quadruple therapy (ACEi/ARB/ARNI, β-blocker, MRA, SGLT2 inhibitor) at discharge in 2022.
- Prescription rates for individual GDMT classes were suboptimal: ACEi/ARB/ARNI (67%), beta-blockers (89%), MRAs (40%), SGLT2 inhibitors (46%).
- Over 90% of patients on ACEi/ARB/ARNI and beta-blockers received ≤50% of target doses at discharge.
- By 6 months, prescription rates declined for ACEi/ARB/ARNI (-16%), beta-blockers (-26%), and MRAs (-7%), while SGLT2 inhibitor use increased.
- Older age and chronic kidney disease were associated with lower odds of receiving quadruple therapy.
- Substantial institutional variation observed in GDMT prescription patterns.
- Conclusions highlight poor uptake and optimization of GDMT, driven by underprescription, inadequate dosing, and discontinuation.
- Suggested interventions include improving clinician awareness, postdischarge support, and addressing institutional practice variation.