Abstract

BACKGROUND Chile has limited data on the treatment of patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). OBJECTIVE This study aimed to evaluate adherence to the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline recommendations, identify barriers to cardiac implantable electronic device (CIED) use, and assess the association between CIED implantation and mortality. METHODS From March 2021 to December 2022, we conducted a prospective, multicenter observational cohort study across 6 hospitals. Adults aged >= 18 with HF with reduced EF <40% were enrolled. Sociodemographic, clinical, and treatment data were collected. Descriptive statistics and Cox univariable regression were performed. RESULTS The study included 243 patients with HF (73.3% male, median age 63 years), with comorbidities, including hypertension (67.1%), diabetes (30%), and obesity (37%); 41.2% had a history of myocardial infarction. At baseline, most patients received betablockers (96%), mineralocorticoid receptor antagonists (84%), and diuretics (65%). Of the 215 patients with LVEF <35%, 34.4% (n = 74) had a baseline CIED: 41.9% (n = 31) implantable cardioverter-defibrillators (ICD), 25.7% (n = 19) cardiac resynchronization therapy defibrillators (CRT-D), 17.6% (n = 13) CRT with a pacemaker, and 14.9% (n = 11) pacemaker. During follow-up, 27 of 75 eligible patients received ICD or CRT-D as recommended by the 2017 ACC/AHA/HRS guideline, whereas 38 did not because of access issues. There were 26 deaths, with no significant mortality differences between those with and without ICD or CRT-D. CONCLUSION In Chile, patients with HFwith reduced LVEF receive pharmacological therapy consistent with international standards; however, they face access barriers to CIEDs, which are underutilized despite their benefits.