Journal of the American Heart Association · 2025
Implementation of the Get With The Guidelines-Heart Failure Adherence to Science, Implementation in Asia (GWTG-HF A.S.I.A.) Program in Taiwan.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Chang Hung-Yu, Liao Chia-Te, Heidenreich Paul A, Allen Larry A, Sung Shih-Hsien, Chen Wen-Jone, Wang Tzung-Dau, Li Yi-Heng, Hsu Chien-Yi, Wu Yen-Wen, Huang Nicole
Аннотация
BACKGROUND: Guideline-directed medical therapy (GDMT) improves outcomes in heart failure with reduced ejection fraction, yet its adoption across Asia remains suboptimal. The American Heart Association launched the GWTG-HF A.S.I.A. (Get With The Guidelines-Heart Failure Adherence to Science, Implementation in Asia) program in 2021. We examined the association between program participation and GDMT implementation in Taiwan.
METHODS: We analyzed 1991 patients with heart failure with reduced ejection fraction enrolled in the Taiwan Society of Cardiology HF Registry (2021-2024). Four hospitals participated in the GWTG-HF A.S.I.A. program (n=462) and 23 nonparticipating hospitals served as controls (n=1529). After propensity-score matching, prescription trends of 4-pillar GDMTs were compared using generalized estimating equations. Primary outcomes were patient-level and hospital-level GDMT prescription rates; secondary outcomes included echocardiographic remodeling, loss to follow-up, and 2-year mortality.
RESULTS: Between 2021 and 2024, GDMT use increased in both groups, with greater gains in participating hospitals. Adjusted odds ratios (aOR) for program participation were 2.73 (95% CI, 2.23-3.34) for 4-pillar GDMTs, 1.59 (95% CI, 1.31-1.92) for angiotensin receptor-neprilysin inhibitors, 2.06 (95% CI, 1.72-2.47) for SGLT2 (sodium-glucose co-transporter 2) inhibitors, and 1.63 (95% CI, 1.34-2.00) for mineralocorticoid receptor antagonists (all P<0.001). After SGLT2 inhibitor reimbursement in 2022, the prescription gap widened. Participating hospitals showed greater left-ventricular reverse remodeling and lower loss-to-follow-up (0.5% versus 5.2%, P<0.001), and 2-year mortality was similar.
CONCLUSIONS: Participation in the GWTG-HF A.S.I.A. program was associated with higher GDMT prescription rates in Taiwanese hospitals. Structured quality improvement initiatives may help bridge the evidence-practice gap in Asia.
METHODS: We analyzed 1991 patients with heart failure with reduced ejection fraction enrolled in the Taiwan Society of Cardiology HF Registry (2021-2024). Four hospitals participated in the GWTG-HF A.S.I.A. program (n=462) and 23 nonparticipating hospitals served as controls (n=1529). After propensity-score matching, prescription trends of 4-pillar GDMTs were compared using generalized estimating equations. Primary outcomes were patient-level and hospital-level GDMT prescription rates; secondary outcomes included echocardiographic remodeling, loss to follow-up, and 2-year mortality.
RESULTS: Between 2021 and 2024, GDMT use increased in both groups, with greater gains in participating hospitals. Adjusted odds ratios (aOR) for program participation were 2.73 (95% CI, 2.23-3.34) for 4-pillar GDMTs, 1.59 (95% CI, 1.31-1.92) for angiotensin receptor-neprilysin inhibitors, 2.06 (95% CI, 1.72-2.47) for SGLT2 (sodium-glucose co-transporter 2) inhibitors, and 1.63 (95% CI, 1.34-2.00) for mineralocorticoid receptor antagonists (all P<0.001). After SGLT2 inhibitor reimbursement in 2022, the prescription gap widened. Participating hospitals showed greater left-ventricular reverse remodeling and lower loss-to-follow-up (0.5% versus 5.2%, P<0.001), and 2-year mortality was similar.
CONCLUSIONS: Participation in the GWTG-HF A.S.I.A. program was associated with higher GDMT prescription rates in Taiwanese hospitals. Structured quality improvement initiatives may help bridge the evidence-practice gap in Asia.