Abstract 13822: Guideline Directed Medical Treatment in Patients With Heart Failure in China

Introduction: Patients with Heart Failure (HF) are often treated at less than target dose or lack Guideline Directed Medical Treatments (GDMT), this has also been reported for patients with HF with reduced ejection fraction (HFrEF) in China. However, data on treatment patterns in different subgroups by disease onset and ejection fraction phenotypes is scarce. Research Question: What are the patient characteristics and treatment for HF in China in relation to concurrent guidelines? Aim: To describe characteristics of incident and prevalent patients with HF and treatment with GDMT (RAASi, BB and MRAs) for HFrEF patients in China prior to SGLT2i approval for HF. Methods: Data from the Heart Failure Registry at the Chinese Cardiovascular Association Heart Failure Center from Jan. 1, 2018 to July 31, 2021 was used. Data on the first 10 new HF inpatients each month is recorded on a case report form at discharge and 1-, 3- and 12-months follow-up. GDMT at discharge and 12 months was described for HFrEF patients. Results: We identified 32047 patients with HF: 21698 incident and 10349 prevalent cases, 13117 (40.9%) HFrEF, 6,368 (19.9%) HFmrEF, 10826 (33.8%) HFpEF and 1736 (5.4%) had no EF measurement. Mean age was 64.8 years in incident and 66.1 years in prevalent patients. A larger proportion of HFpEF patients were women than in other EF phenotypes. At discharge, 71.2% of incident and 75.7% of prevalent patients were treated with RAASi, 77.9% and 81.2% were treated with BB and 65.7% and 75.8% with MRA. Treatment was consistently lower at 12 months. In HFrEF 65.6% and 69.2% of incident and prevalent patients had three GDMTs at discharge; 37.3% and 39.9% at 12 months. Patient target/maximum tolerated dose for incident HFrEF patients was reached for17.6% (RAASi), 28.3% (BB) and 48.7% (MRA); for prevalent this was 24.8%, 38.4% and 50.8%. Conclusions: In this study on HF patients in Chinese clinical practice, 40% had HFrEF whereas the majority had preserved or mildly reduced EF. In the HFrEF patients, less than half of patients had three concurrent GDMTs at 12 months. Moreover, few patients received the target dose at 12 months and many discontinued treatment. These results show an urgent need for improved treatment strategies and effective implementation of new guidelines in China.