TY - JOUR T1 - Heart failure medication dosage and survival in women and men seen at outpatient clinics JF - Heart JO - Heart SP - 1748 LP - 1755 DO - 10.1136/heartjnl-2021-319229 VL - 107 IS - 21 AU - Sophie Heleen Bots AU - N Charlotte Onland-Moret AU - Igor I Tulevski AU - Pim van der Harst AU - Maarten J M Cramer AU - Folkert W Asselbergs AU - G Aernout Somsen AU - Hester M den Ruijter Y1 - 2021/11/01 UR - http://heart.bmj.com/content/107/21/1748.abstract N2 - Objective Women with heart failure with reduced ejection fraction (HFrEF) may reach optimal treatment effect at half of the guideline-recommended medication dose. This study investigates prescription practice and its relation with survival of patients with HF in daily care.Methods Electronic health record data from 13 Dutch outpatient cardiology clinics were extracted for HF receiving at least one guideline-recommended HF medication. Dose changes over consecutive prescriptions were modelled using natural cubic splines. Inverse probability-weighted Cox regression was used to assess the relationship between dose (reference≥50% target dose) and all-cause mortality.Results The study population comprised 561 women (29% HFrEF (ejection fraction (EF)<40%), 49% heart failure with preserved ejection fraction (EF≥50%); HFpEF and 615 men (47% and 25%, respectively). During a median follow-up of 3.7 years, 252 patients died (48% women; 167 HFrEF, 84 HFpEF). Nine hundred thirty-four patients (46% women) received ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 795 (48% women) beta blockers and 178 (42% women) mineralocorticoid receptor antagonists (MRAs). In both sexes, the mean target dose across prescriptions was 50% for ACEI/ARBs and beta blockers, and 100% for MRAs. ACEI/ARB dose of <50% was associated with lower mortality in women but not in men with HFrEF. This was not seen in patients with HFpEF. Beta-blocker dose was not associated with all-cause mortality.Conclusion Patients with HF seen in outpatient cardiology clinics receive half of the guideline-recommended medication dose. Lower ACEI/ARB dose was associated with improved survival in women with HFrEF. These results underscore the importance of (re)defining optimal medical therapy for women with HFrEF.Data are not available. The Cardiology Centers of the Netherlands database cannot be shared outside the University Medical Center Utrecht's infrastructure because of ethical constraints. The data obtained from Statistics Netherlands are project-specific and cannot be accessed by unregistered researchers. ER -