The Real-World Use of Guideline-Directed Medical Therapy in Patients with Heart Failure with Reduced Ejection Fraction Newly Initiated on Dapagliflozin: An EVOLUTION-HF CEE-BA Study (Results from the Baltic Cohort).

Background and

Objectives

Guideline-directed medical therapy (GDMT) remains a challenge due to its low rates worldwide. Adherence to GDMT in patients with heart failure (HF) and reduced ejection fraction (rEF) in the Baltics (Estonia, Latvia, and Lithuania) has been unknown. This is the first study to describe the characteristics of patients with HFrEF and their treatment patterns in the Baltics. Materials and

Methods

The EVOLUTION-HF study was a longitudinal, real-world evidence study that enrolled patients with HFrEF following newly initiated sodium-glucose cotransporter-2 inhibitor (SGLT2i) dapagliflozin therapy. In total, 12 study sites (four from each country) were included. Patients were followed up for 12 months. A pooled data set including adherence to GDMT, dapagliflozin's usage, and patients' profiles was evaluated.

Results

Between April and December 2022, 178 patients with a median left ventricular ejection fraction of 32% were enrolled. At baseline, 155 (87%) patients received renin-angiotensin-aldosterone system inhibitors (RAASi), 168 (94%) received beta-blockers (BB), and 106 (60%) received mineralocorticoid receptor antagonists (MRA); however, only 47.8% of the study population were found to be treated with GDMT (including RAASi, BB, MRA, and dapagliflozin) at the beginning of the study. At the end of the follow-up, the percentage of GDMT users decreased to 42.3%. The number of dapagliflozin discontinuations per 100 patient-years was found to be 13.2 (95% CI 8.2-18.2).

Conclusions

The findings indicate a low rate of dapagliflozin discontinuation (13%) and an overall suboptimal proportion of patients receiving GDMT for HFrEF (almost half of the patients). The low rate of GDMT use in the Baltics prompts great attention. Additional research and incremental joint efforts are needed to ensure an increase in GDMT use across diverse HF patient populations.