Patients with heart failure with reduced ejection fraction (HFrEF) who are prescribed five or more non-guideline-directed medical therapy (GDMT) drugs are more likely to underuse optimal therapy, according to a post hoc analysis of the GUIDE-IT trial. The analysis showed that 46.5% of patients were prescribed five or more non-GDMT medications, which was common among older patients with a greater burden of comorbidities, frailty and severity of HF. Patients with polypharmacy were 16% less likely to achieve GDMT during follow-up, despite being at greater risk of adverse outcomes, and the underuse of optimal GDMT may be related to age and greater inertia to uptitration. The researchers recommended further research on ideal multidisciplinary interventions to lower the polypharmacy burden and improve GDMT uptake among patients with HFrEF.
