Abstract
Background: Contemporary heart failure with reduced ejection fraction (HFrEF) management is based on four foundational pharmacologic therapies: renin-angiotensin system inhibition, preferably with an angiotensin receptor-neprilysin inhibitor (ARNI); an evidence-based beta-blocker; a mineralocorticoid receptor antagonist (MRA); and a sodium-glucose cotransporter-2 inhibitor (SGLT2i). Real-world implementation remains variable.
Objective: To examine contemporary HFrEF pharmacotherapy in a published United Arab Emirates (UAE) retrospective cohort and benchmark medication use against Canadian real-world data and Canadian guideline recommendations.
Methods: Published retrospective UAE data from adults hospitalized with heart failure at Zayed Military Hospital during 2024 were evaluated, focusing on the HFrEF subgroup. Class-specific use of foundational HFrEF therapy was compared with a Canadian retrospective cohort from the Regina Heart Function Clinic and with Canadian population-level data.
Results: The UAE cohort included 152 patients with heart failure, of whom 87 (57.2%) had HFrEF. Among patients with HFrEF, 72/87 (82.8%) received an ACE inhibitor, angiotensin receptor blocker, or ARNI; 82/87 (94.3%) received a beta-blocker; 65/87 (74.7%) received an SGLT2 inhibitor; and 19/87 (21.8%) received an MRA. In comparison, among 129 patients attending a specialized Canadian heart-function clinic, optimized therapy was documented in 82.2% for renin-angiotensin system inhibition, 79.1% for beta-blockers, 80.6% for MRAs, and 74.4% for SGLT2 inhibitors; 47.3% received optimized four-pillar therapy. The major difference between the UAE and Canadian cohorts was MRA utilization.
Conclusion: Contemporary UAE practice demonstrates high uptake of beta-blockers, renin-angiotensin system inhibitors, and SGLT2 inhibitors in hospitalized patients with HFrEF, but substantial underutilization of MRAs. Comparison with Canadian specialized-care data suggests that systematic medication review, documentation of contraindications, multidisciplinary care, and structured post-discharge optimization may improve four-pillar GDMT implementation.
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Ethics & Declarations
Author Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. All authors read and approved the final manuscript.
Ethics Approval and Consent to Participate
Not applicable. This study did not involve human participants, animal experimentation, or confidential patient clinical data. All data was collected retrospectively from patients' charts. No patient data was used or published in this study.
Consent for Publication
Not applicable, or informed consent for publication was obtained from all individual participants where relevant.
Competing Interests
The authors declare that they have no competing financial or non-financial interests.
Funding
The authors declare that no funds, grants, or other financial support were received during the preparation of this manuscript.
Data Availability Statement
Data sharing is not applicable to this article as no new datasets were generated or analyzed during the current study.
References
-
1.
McDonald M, Virani S, Chan M, et al. CCS/CHFS Heart Failure Guidelines Update: defining a new pharmacologic standard of care for heart failure with reduced ejection fraction. Can J Cardiol. 2021;37(4):531-546.
-
2.
Jumani AI, Rashwan GA, Ibrahim HO, Almohdar SM, Alfakih KM. Etiology, management, and outcomes of hospitalized heart failure patients: a single-center study. Saudi Med J. 2026;47(7):1168-1174. doi:10.15537/1658-3175.8805.
-
3.
McVannel T, Albers L, Kosar L, et al. Evaluation of guideline-directed medical therapy for outpatients living with heart failure with reduced ejection fraction. Can J Hosp Pharm. 2024;77(1). doi:10.4212/cjhp.3373.
-
4.
Wahid M, Aghanya V, Sepehrvand N, et al. Use of guideline-directed medical therapy in patients aged ≥65 years after the diagnosis of heart failure: a Canadian population-based study. CJC Open. 2022;4(12):1015-1023.
-
5.
Jan RK, Alsheikh-Ali A, Al Mulla A, et al. Outcomes of guideline-based medical therapy in patients with acute heart failure and reduced left ventricular ejection fraction: observations from the Gulf acute heart failure registry. Medicine (Baltimore). 2022;101(23). doi:10.1097/MD.0000000000029452.
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© 2026 Judy Zimmerman et al. International Journal of Clinical Pharmacy and Medicine.