Use of Guideline-Recommended Heart Failure Drugs in High-, Middle-, and Low-Income Countries: A Systematic Review and Meta-Analysis.

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Global Heart Pub Date : 2024-09-12 eCollection Date: 2024-01-01 DOI:10.5334/gh.1355

Gautam Satheesh, Rupasvi Dhurjati, Laura Alston, Fisaha Tesfay, Rashmi Pant, Ehete Bahiru, Claudia Bambs, Anubha Agarwal, Sanne A E Peters, Abdul Salam, Isabelle Johansson

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引用次数: 0

Abstract

Optimal use of guideline-directed medical therapy (GDMT) can prevent hospitalization and mortality among patients with heart failure (HF). We aimed to assess the prevalence of GDMT use for HF across geographic regions and country-income levels. We systematically reviewed observational studies (published between January 2010 and October 2020) involving patients with HF with reduced ejection fraction. We conducted random-effects meta-analyses to obtain summary estimates. We included 334 studies comprising 1,507,849 patients (31% female). The majority (82%) of studies were from high-income countries, with Europe (45%) and the Americas (33%) being the most represented regions, and Africa (1%) being the least. Overall prevalence of GDMT use was 80% (95% CI 78%-81%) for β-blockers, 82% (80%-83%) for renin-angiotensin-system inhibitors, and 41% (39%-43%) for mineralocorticoid receptor antagonists. We observed an exponential increase in GDMT use over time after adjusting for country-income levels (p < 0.0001), but significant gaps persist in low- and middle-income countries. Multi-level interventions are needed to address health-system, provider, and patient-level barriers to GDMT use.

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在高、中、低收入国家使用指南推荐的心衰药物：系统回顾与元分析》。

最佳使用指导性医疗疗法（GDMT）可以预防心力衰竭（HF）患者住院和死亡。我们旨在评估不同地理区域和不同国家收入水平的心衰患者使用指导性医疗疗法（GDMT）的普遍程度。我们系统回顾了涉及射血分数降低的心力衰竭患者的观察性研究（发表于 2010 年 1 月至 2020 年 10 月）。我们进行了随机效应荟萃分析，以获得汇总估计值。我们纳入了 334 项研究，包括 1,507,849 名患者（31% 为女性）。大多数研究（82%）来自高收入国家，欧洲（45%）和美洲（33%）是研究最多的地区，非洲（1%）最少。β受体阻滞剂的 GDMT 使用率为 80%（95% CI 78%-81%），肾素-血管紧张素系统抑制剂为 82%（80%-83%），矿物质皮质激素受体拮抗剂为 41%（39%-43%）。根据国家收入水平进行调整后，我们观察到随着时间的推移，GDMT 的使用呈指数增长（p < 0.0001），但在低收入和中等收入国家仍存在显著差距。需要采取多层次的干预措施，以解决医疗系统、医疗服务提供者和患者层面在使用 GDMT 方面的障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Global Heart Medicine-Cardiology and Cardiovascular Medicine

CiteScore

5.70

自引率

5.40%

发文量

审稿时长

5 weeks

期刊介绍： Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.