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HFrEF Prognosis With and Without GDMT — EECC MCQ

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EasyHeart FailureHFrEF Prognosis With and Without GDMTEECC

A 50-year-old man with newly diagnosed HFrEF (LVEF 22%) asks about his prognosis. Without treatment, what is the approximate 1-year mortality for severe HFrEF?

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Correct answer: C — Without treatment, 1-year mortality for NYHA III-IV HFrEF is approximately 25-50%; with optimised quadruple GDMT the mortality reduction is estimated at 60-70%, transforming the prognosis — early and complete GDMT implementation is therefore critical

The natural history of untreated severe HFrEF is grim: 1-year mortality for NYHA III-IV was approximately 40-60% in the pre-treatment era (CONSENSUS trial placebo arm: 52% 1-year mortality). Modern quadruple GDMT has transformed this: (1) each pillar provides independent additive mortality benefit (beta-blocker ~34%, ACEi/ARNI ~20-23%, MRA ~30%, SGLT2i ~13%); (2) the cumulative estimated mortality reduction with all four agents is ~60-70% compared with no treatment; (3) additional device therapy (ICD for SCD prevention, CRT for resynchronisation) further improves outcomes. The 2023 ESC HF Guidelines emphasise rapid initiation and uptitration of all four GDMT pillars simultaneously (STRONG-HF protocol) to maximise early benefit. The message: every day without optimised GDMT is a missed opportunity for mortality reduction.

Reference: ESC (2023): HF Guidelines; CONSENSUS Trial