Titration of medications and outcomes in multi-ethnic heart failure cohorts (with reduced ejection fraction) from Singapore and New Zealand

Aims: We investigated titration patterns of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers(ARBs) and beta-blockers, quality of life (QoL) over 6 months, and associated 1 year outcome [all-cause mortality/heart failure(HF) hospitalization] in a real-world population with HF with reduced ejection fraction (HFrEF).
Methods and results: Participants with HFrEF (left ventricular ejection fraction80% of patients, mineralocorticoid receptor antagonist in about half of patients, and statins in>90% of pa-tients. At baseline, only 11% and 9% received 100% GRD for each drug class, respectively, with about half (47%) achieving≥50% GRD for ACEis/ARBs or beta-blockers. At 6 months, a large majority remained in the‘stay low’category, one third re-mained in‘stay high’, whereas 10–16% up-titrated and 4–6% down-titrated. Patients with lower (vs. higher) N-terminal pro-beta-type natriuretic peptide levels were more likely to be up-titrated or be in‘stay high’for ACEis/ARBs and beta-blockers(P= 0.002). Ischaemic aetiology, prior HF hospitalization, and enrolment in Singapore (vs. New Zealand) were independentlyassociated with higher odds of‘staying low’(allP