{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T07:07:07Z","timestamp":1793862427653,"version":"4.6.1"},"reference-count":14,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"Importance<\/jats:title>Guideline-directed medical therapy (GDMT) remains underutilized on a global level, with significant disparities in access to treatment worldwide. The potential global benefits of quadruple therapy on patients with heart failure with reduced ejection fraction (HFrEF) have not yet been estimated.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the projected population-level benefit of optimal GDMT use globally among patients with HFrEF.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Estimates for HFrEF prevalence, contraindications to GDMT, treatment rates, and the number needed to treat for all-cause mortality at 12 months were derived from previously published sources. Potential lives saved from optimal implementation of quadruple therapy among patients with HFrEF was calculated globally and a sensitivity analysis was conducted to account for uncertainty in the existing data.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>All-cause mortality.<\/jats:p><\/jats:sec>Results<\/jats:title>Of an estimated 28.89 million people with HFrEF worldwide, there were 8 235 063 (95% CI, 6 296 020-10 762 972) potentially eligible for but not receiving \u03b2-blockers, 20 387 000 (95% CI, 15 867 004-26 184 996) eligible for but not receiving angiotensin receptor\u2013neprilysin inhibitors, 12 223 700 (95% CI, 9 376 895-15 924 973) eligible for but not receiving mineralocorticoid receptor antagonists, and 21 229 170 (95% CI, 16 537 400-27 242 688) eligible for but not receiving sodium glucose cotransporter-2 inhibitors. Optimal implementation of quadruple GDMT could potentially prevent 1 188 277 (95% CI, 767 933-1 914 561) deaths over 12 months. A large proportion of deaths averted were projected in Southeast Asia, Eastern Mediterranean and Africa, and the Western Pacific regions.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Improvement in use of GDMT could result in substantial mortality benefits on a global scale. Significant heterogeneity also exists across regions, which warrants additional study with interventions tailored to country-level differences for optimization of GDMT worldwide.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2024.3023","type":"journal-article","created":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T15:36:29Z","timestamp":1727883389000},"page":"1154","source":"Crossref","is-referenced-by-count":36,"title":["Global Impact of Optimal Implementation of Guideline-Directed Medical Therapy in Heart Failure"],"prefix":"10.1001","volume":"9","author":[{"given":"Amber B.","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Medicine, UCLA, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boback","family":"Ziaeian","sequence":"additional","affiliation":[{"name":"Division of Cardiology, UCLA, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Research Institute, Dallas, Texas"},{"name":"University of Mississippi, Jackson, Mississippi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clyde W.","family":"Yancy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Deputy Editor, JAMA Cardiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Division of Cardiology, UCLA, Los Angeles, California"},{"name":"Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"17","key":"hbr240012r1","doi-asserted-by":"publisher","first-page":"e263","DOI":"10.1016\/j.jacc.2021.12.012","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines.","volume":"79","author":"Heidenreich","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"6","key":"hbr240012r2","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1016\/j.ahj.2011.01.027","article-title":"Potential impact of optimal implementation of evidence-based heart failure therapies on mortality.","volume":"161","author":"Fonarow","year":"2011","journal-title":"Am Heart J"},{"issue":"6","key":"hbr240012r3","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1001\/jamacardio.2016.1724","article-title":"Potential mortality reduction with optimal implementation of angiotensin receptor neprilysin inhibitor therapy in heart failure.","volume":"1","author":"Fonarow","year":"2016","journal-title":"JAMA Cardiol"},{"issue":"8","key":"hbr240012r4","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1001\/jamacardio.2020.0898","article-title":"Association of optimal implementation of sodium-glucose cotransporter 2 inhibitor therapy with outcome for patients with heart failure.","volume":"5","author":"Bassi","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"2","key":"hbr240012r5","doi-asserted-by":"publisher","first-page":"244","DOI":"10.21037\/cdt.2019.08.03","article-title":"An overview of heart failure in low- and middle-income countries.","volume":"10","author":"Agbor","year":"2020","journal-title":"Cardiovasc Diagn Ther"},{"issue":"6","key":"hbr240012r6","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.027852","article-title":"Burden, trends, and inequalities of heart failure globally, 1990 to 2019: a secondary analysis based on the global burden of disease 2019 study.","volume":"12","author":"Yan","year":"2023","journal-title":"J Am Heart Assoc"},{"issue":"7","key":"hbr240012r7","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1002\/ejhf.2864","article-title":"Potential global impact of sodium-glucose cotransporter-2 inhibitors in heart failure.","volume":"25","author":"Talha","year":"2023","journal-title":"Eur J Heart Fail"},{"issue":"8","key":"hbr240012r8","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1016\/j.jchf.2024.03.001","article-title":"Eligibility and projected benefits of rapid initiation of quadruple medical therapy for newly diagnosed heart failure.","volume":"12","author":"Greene","year":"2024","journal-title":"JACC Heart Fail"},{"issue":"3","key":"hbr240012r9","doi-asserted-by":"publisher","first-page":"e411","DOI":"10.1016\/S2214-109X(20)30004-8","article-title":"Post-discharge prognosis of patients admitted to hospital for heart failure by world region, and national level of income and income disparity (REPORT-HF): a cohort study.","volume":"8","author":"Tromp","year":"2020","journal-title":"Lancet Glob Health"},{"issue":"1","key":"hbr240012r10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jchf.2022.08.009","article-title":"Heart failure drug treatment\u2014inertia, titration, and discontinuation: a multinational observational study (EVOLUTION HF).","volume":"11","author":"Savarese","year":"2023","journal-title":"JACC Heart Fail"},{"issue":"7","key":"hbr240012r11","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1001\/jamacardio.2023.1266","article-title":"Contemporary use of sodium-glucose cotransporter-2 inhibitor therapy among patients hospitalized for heart failure with reduced ejection fraction in the US: the Get With The Guidelines\u2013Heart Failure Registry.","volume":"8","author":"Pierce","year":"2023","journal-title":"JAMA Cardiol"},{"issue":"22","key":"hbr240012r12","doi-asserted-by":"publisher","first-page":"1844","DOI":"10.1136\/hrt.2009.174276","article-title":"Potential survival gains in the treatment of myocardial infarction.","volume":"95","author":"Chew","year":"2009","journal-title":"Heart"},{"issue":"10244","key":"hbr240012r13","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/S0140-6736(20)30748-0","article-title":"Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials.","volume":"396","author":"Vaduganathan","year":"2020","journal-title":"Lancet"},{"key":"hbr240012r14","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.pcad.2024.01.008","article-title":"Bridging gaps and optimizing implementation of guideline-directed medical therapy for heart failure.","volume":"82","author":"Shahid","year":"2024","journal-title":"Prog Cardiovasc Dis"}],"container-title":["JAMA Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/articlepdf\/2824002\/jamacardiology_tang_2024_br_240012_1733417077.76838.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T20:35:52Z","timestamp":1733949352000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/fullarticle\/2824002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,1]]},"references-count":14,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamacardio.2024.3023","relation":{},"ISSN":["2380-6583"],"issn-type":[{"value":"2380-6583","type":"print"}],"subject":[],"published":{"date-parts":[[2024,12,1]]}}}