Kosin Medical Journal

Original article

A single-center analysis of guideline-directed medical therapy in patients with heart failure with mildly reduced or preserved ejection fraction according to current heart failure guidelines: Bong-Joon Kim, Suhyun Bae, Soo-Jin Kim, Sung-Il Im, Jung-Ho Heo; Kosin Med J. 2025;40(4):280-289. Published online December 26, 2025; DOI: https://doi.org/10.7180/kmj.25.124

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Background
Recent landmark trials have shown that several pharmacologic therapies improve outcomes in patients with heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF), leading to updates in heart failure (HF) management guidelines. However, real-world adherence to guideline-directed medical therapy (GDMT) in these populations remains uncertain. This study evaluated GDMT prescription patterns in patients with HFmrEF or HFpEF based on the 2022 Korean Heart Failure Society guidelines.
Methods
This single-center observational study included patients newly diagnosed with HF between January and December 2023, identified using International Classification of Diseases codes. Patients without recent echocardiographic or N-terminal pro–brain natriuretic peptide data, those with reduced ejection fraction, or those with end-stage renal disease were excluded. Electronic medical records were reviewed to assess GDMT prescription rates.
Results
Among 615 patients (mean age, 68.9 years; 52.4% female), 568 had HFpEF and 47 had HFmrEF. Common comorbidities included hypertension (75.5%), diabetes mellitus (50.9%), ischemic heart disease (43.7%), and chronic kidney disease (22.6%). Overall prescription rates were 73.3% for renin–angiotensin system inhibitors, 83.7% for beta-blockers, 41.1% for mineralocorticoid receptor antagonists (MRAs), and 42.9% for sodium–glucose cotransporter 2 inhibitors (SGLT2is). SGLT2i use was significantly higher in patients with diabetes than in those without (71.6% vs. 13.2%; p<0.001). Angiotensin receptor–neprilysin inhibitors and MRAs were more frequently prescribed in HFmrEF than HFpEF. Beta-blocker use was lower in patients aged ≥75 years.
Conclusions
A substantial gap persists between guideline recommendations and real-world GDMT use in patients with HFmrEF and HFpEF, particularly for SGLT2is. Multicenter studies are warranted to further characterize and address this treatment gap.

Citations

Citations to this article as recorded by

Bridging the gap between guidelines and real-world practice for heart failure with mildly reduced or preserved ejection fraction
Hidenori Yaku
Kosin Medical Journal.2025; 40(4): 239. CrossRef

Review article

The role of the interatrial shunt device in the treatment of patients with heart failure with preserved ejection fraction: experience from the REDUCE LAP-HF studies: Bong-Joon Kim; Kosin Med J. 2025;40(2):88-95. Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.150

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Abstract PDF PubReader ePub: Heart failure with preserved ejection fraction (HFpEF) is characterized by increased left ventricular filling pressure and elevated left atrial pressure. Despite advances in medical treatments, the management of HFpEF patients is often challenging due to multiple comorbidities, leading to polypharmacy and associated side effects. Consequently, there is an increasing demand for procedural or device-based therapies in HFpEF management. Over the past decade, the transcatheter interatrial shunt device (IASD), designed to create a passage between the left atrium and the right atrium, has emerged as a novel therapeutic option. The IASD offers potential benefits by reducing left atrial pressure at rest and during exercise. The efficacy and safety of the IASD were demonstrated in the REDUCE LAP-HF (Reduce Left Atrial Pressure in Patients with Heart Failure) study series. Furthermore, IASD has been shown to support positive cardiac remodeling. With the availability of more data, appropriate indications for the use of IASDs are becoming more evident, and criteria for patient selection in future studies are needed.

Case report

Total intravenous anesthesia using remimazolam for patients with heart failure with reduced ejection fraction: a case series: Jimin Lee, Ji-Uk Yoon, Gyeong-Jo Byeon, Hong-Sik Shon, Ahhyeon Yi, Hee Young Kim; Kosin Med J. 2024;39(2):144-149. Published online May 9, 2024; DOI: https://doi.org/10.7180/kmj.23.156

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Abstract PDF PubReader ePub: Patients with heart failure undergoing surgery that requires general anesthesia face substantial perioperative risks; however, clear guidelines are not available for anesthesia management in patients with a reduced left ventricular ejection fraction. Traditional intravenous and volatile anesthetics require careful administration to prevent severe hypotension and bradycardia in patients with heart failure. Remimazolam has emerged as a promising alternative to conventional anesthetics because of its reduced cardiovascular depressive effects. We present three cases illustrating the successful use of remimazolam to induce and maintain general anesthesia in patients with heart failure and reduced cardiac function. Our cases demonstrate the safe use of remimazolam for general anesthesia in patients with heart failure and a reduced ejection fraction.

Review article

Role of biomarkers in the heart failure clinic: Bong-Joon Kim, Jae-Hyeong Park; Kosin Med J. 2022;37(1):4-17. Published online March 29, 2022; DOI: https://doi.org/10.7180/kmj.22.019

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Abstract PDF PubReader ePub

Heart failure (HF) is a common cardiovascular disease that has a complex pathophysiology. Because it is the final stage of many cardiovascular diseases, proper diagnosis and treatment are crucial for prolonging patients’ survival and improving their well-being. Several biomarkers have been identified in HF, and their roles in diagnosis and prognostication have been widely investigated. Among them, natriuretic peptides are key for diagnosing HF, predicting its prognosis, and monitoring the effectiveness of HF treatment. Moreover, natriuretic peptides can also be used to treat HF. In addition to natriuretic peptides, several other biomarkers were included in the most recent HF management guidelines. Thus, we reviewed the role of the biomarkers included in these guidelines and discussed future perspectives.

Citations

Citations to this article as recorded by

Impact of Pharmacotherapy Optimization on Health-related Quality of Life in a Long-term Follow-up Program for Patients with Heart Failure
Rasa Paleckiene, Diana Zaliaduonyte, Jurate Macijauskiene
Open Medicine Journal.2025;[Epub] CrossRef
The role of the interatrial shunt device in the treatment of patients with heart failure with preserved ejection fraction: experience from the REDUCE LAP-HF studies
Bong-Joon Kim
Kosin Medical Journal.2025; 40(2): 88. CrossRef

Case report

Dual Chamber Pacemaker Therapy in a Patient with Congestive Heart Failure and Left Bundle Branch Block: Chan Ook Kim, Tae Joon Cha, Seong Man Kim, Min Dae Kim, Sung Il Kwon, Soo Hong Seo, Byung Joo Choi, Seung Jae Joo, Jae Woo Lee; Kosin Med J. 2002;17(1):142-146.

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