Implementation of the Get With The Guidelines-Heart Failure Adherence to Science, Implementation in Asia (GWTG-HF A.S.I.A.) Program in Taiwan.

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.