Berge Kristian, Schirmer Henrik, Øvrebotten Tarjei, Nahoui Hamza, Gullestad Lars, Ingul Charlotte Björk, Hole Torstein, Mo Rune, Larsby Kristina, Norekvål Tone M, Omland Torbjørn, Ørn Stein, Myhre Peder L
Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
ESC Heart Fail. 2025 Jun 27. doi: 10.1002/ehf2.15337.
The guideline-directed medical therapy (GDMT) sequencing strategy for patients with heart failure (HF) and reduced ejection fraction (HFrEF) underwent a paradigm shift with the 2021 ESC HF guidelines, from stepwise escalation to rapid simultaneous initiation of quadruple therapy. We aimed to assess the temporal trends in the use of GDMT and prognosis for patients with HFrEF.
Through the Norwegian HF Registry, we obtained data on patients treated at HF outpatient clinics with left ventricular ejection fraction ≤40% from 2016 through 2023 (n = 13 992), including GDMT, HF hospitalisations and mortality. Since 2016, >90% of patients have been treated with beta-blockers and renin-angiotensin-system-inhibitors, with angiotensin receptor-neprilysin inhibitors (ARNI) utilisation increasing from 4% in 2016 to 54% in 2023. Mineralocorticoid-receptor-antagonists (MRA) utilisation was at 36% in 2016, increased by 3% per year to 54% in 2021, and thereafter increased by 12% per year to 78% in 2023. Sodium-glucose cotransporter-2-inhibitors (SGLT2i) utilisation increased rapidly from 3% in 2020 to 85% in 2023. The utilisation of ≥50% of target dose followed similar trends. From 2016 to 2021, the crude 6-month mortality rate remained at 2.7%, followed by a decline of approximately 0.5% per year to 1.8% in 2023. HF hospitalisations declined steadily from 12.9% in 2016 to 8.2% in 2021, with a further decline to 6.8% in 2023.
The utilisation of GDMT in Norwegian HF clinics has increased markedly since 2016, with a fourfold acceleration in MRA and a substantial increase in SGLT2i use following the 2021 ESC HF guidelines. HF hospitalisations have consistently declined, while mortality rates first declined after 2021.
随着2021年欧洲心脏病学会（ESC）心力衰竭指南的发布，射血分数降低的心力衰竭（HFrEF）患者的指南导向药物治疗（GDMT）排序策略发生了范式转变，从逐步升级转变为快速同时启动四联疗法。我们旨在评估HFrEF患者使用GDMT的时间趋势及其预后。
通过挪威心力衰竭登记处，我们获取了2016年至2023年期间在心力衰竭门诊接受治疗且左心室射血分数≤40%的患者的数据（n = 13992），包括GDMT、心力衰竭住院情况和死亡率。自2016年以来，超过90%的患者接受了β受体阻滞剂和肾素-血管紧张素系统抑制剂治疗，血管紧张素受体脑啡肽酶抑制剂（ARNI）的使用率从2016年的4%增至2023年的54%。盐皮质激素受体拮抗剂（MRA）的使用率在2016年为36%，每年增加3%，至2021年达到54%，此后每年增加12%，至2023年达到78%。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）的使用率从2020年的3%迅速增至2023年的85%。达到≥50%目标剂量的使用率也呈现类似趋势。从2016年到2021年，粗6个月死亡率维持在2.7%，随后每年下降约0.5%，至2023年降至1.8%。心力衰竭住院率从2016年的12.9%稳步下降至2021年的8.2%，2023年进一步降至6.8%。
自2016年以来，挪威心力衰竭诊所中GDMT的使用率显著增加，遵循2021年ESC心力衰竭指南后，MRA的使用率增长了四倍，SGLT2i的使用大幅增加。心力衰竭住院率持续下降，而死亡率在2021年后开始下降。
