# Pharmacological treatment of patients with chronic heart failure. Subanalysis of an Ecuadorian registry

## TL;DR

This study from Ecuador found that a combination of three heart failure drugs improves survival in patients with reduced ejection fraction, but not in those with preserved ejection fraction.

## Contribution

The study provides new evidence on drug therapy effectiveness in chronic heart failure patients in Ecuador, particularly for triple therapy combinations.

## Key findings

- Triple therapy (ACEI/ARB/ARNI + BB + MRA) was associated with lower all-cause mortality in HFrEF patients.
- No mortality differences were observed in HFpEF patients based on medication use.
- ARNI + BB + MRA combination showed better survival outcomes compared to other drug combinations in HFrEF.

## Abstract

Introduction. In Ecuador, there is limited data on the treatment of patients with heart failure (HF).

This study aimed to determine the rate of use of prognosis-modifying drugs and their association with prognosis.

A retrospective observational study was conducted on patients with chronic HF included in the “Los Ceibos” registry between January 2017 and December 2022. Patients were followed for a median of 2.28 years (interquartile range [IQR]: 1.25-3.49).

A total of 711 patients diagnosed with HF were included. Among them, 82.7% (n=588) received angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNIs); 82.3% (n=585) received beta-blockers (BBs); and 51.3% (n=365) were treated with mineralocorticoid receptor antagonists (MRAs). Among patients with HFrEF, those receiving triple therapy (ACEI/ARB/ARNI + BB + MRA) had lower all-cause mortality compared to other groups (38.8%, log-rank p=0.014). In patients with Heart Failure with preserved Ejection Fraction (HFpEF), no mortality differences were observed according to the number of medications used (log-rank p=0.720). MRA use was not associated with a prognostic benefit in HFpEF (p>0.05). Patients receiving triple therapy with ARNI + BB + MRA had better survival during follow-up compared to any other drug combination (log-rank p=0.027).

A high rate of ACEI/ARB/ARNI and BB use was observed. The use of triple therapy, particularly the combination of ARNI + BB + MRA, was associated with improved prognosis in patients with HFrEF over a four-year follow-up period. No prognostic benefit of MRA use was observed in patients with HFpEF.