Heart failure is a rapidly growing public health issue that can be difficult to manage on a global scale. But there are tools that exist that can improve outcomes, such as guideline-directed medical therapy (GDMT).

New UCLA-led research highlights the important role that these guidelines can play in reducing mortality rates for individuals suffering from heart failure with reduced ejection fraction (HFrEF), a type of heart failure affecting an estimated 29 million people worldwide.

“These guidelines are being significantly underutilized in clinical settings globally and there are barriers that contribute to this, including poor health literacy, limited access to care and medication costs,” said Dr. Amber Tang, the lead author of the study and a medical resident at UCLA.

The study, published in JAMA Cardiology, found that of the estimated 29 million people worldwide with HFrEF, many who were eligible to receive life-saving treatment did not receive treatment (8.2 million individuals for beta blocker treatment; 20.4 million individuals for angiotensin receptor neprilysin inhibitors treatment; 12.2 million individuals for mineralocorticoid receptor antagonists treatment; and 21.2 million for SGLT2 inhibitors treatment), demonstrating the challenge in implementing these global guidelines.

However, with optimal implementation, researchers predict that the use of GDMT could prevent 1.2 million deaths per year worldwide, with more than one million lives saved in the Eastern Mediterranean, Southeast Asia and Western Pacific.

The study, which examined existing patient data published from large registries to estimate heart failure prevalence, GDMT eligibility, current prescription rates, and potential lives saved across the world, is the first to estimate the mortality benefit of individuals with HFrEF globally, rather than just in the United States.

“There are significant regional disparities that exist across the world, and this study draws attention to the fact that heart failure is not a monolithic entity, but a condition that varies greatly based on socioeconomic and cultural nuances,” said Dr. Gregg Fonarow, senior author of the study and director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of UCLA’s Preventative Cardiology Program.

Researchers say these findings highlight the significance of heart failure as a global health issue. “To see calculated projections of the potential number of lives saved each year allows the public and the medical community to see the magnitude of the problem and the urgency needed to bring therapeutic interventions to people around the world.”