OPTIHEART: Determinants and prognostic importance of optimal medical treatment in patients with heart failure with reduced ejection fraction discharged from a heart failure clinic from 2018 to 2020

Heart failure (HF) is an increasing health problem globally. Profound sex-related differences have been observed regarding the cause, treatment, and prognosis of HF. To assess baseline predictors for achieving optimal medical treatment (OMT) and the prognostic importance of OMT for male and female patients who have attended a HF clinical program (HFCP). OPTIHEART was a retrospective study that included 870 consecutive patients with left ventricular ejection fraction (LVEF)&lt;40% discharged from HFCP in 2018, 2019 or 2020 and followed in registers for a mean of 1083(SD 11.3) days. OMT was defined as receiving an angiotensin-converting-enzyme-inhibitor (ACEi), angiotensin-receptor blocker (ARB) or angiotensin-II-receptor blocker and nephrylisin-inhibitor (ARNI) AND a betablocker (BB) both in doses &gt; 50% of target doses. Achieving OMT was associated with male sex (OR: 2.05 95%CI 1.44-2.97; <i>P</i> &lt; 0.0001) independently of younger age, higher diastolic blood pressure (DBP), and lower creatinine. A lower rate of 5-point MACE was associated with achieved OMT (HR: 0.67 95%CI 0.50-0.90; <i>P</i> = 0.007) independently of female sex (HR: 0.64 95%CI 0.48-0.84; <i>P</i> = 0.002), younger age, never smoking and NYHA ≤ 2. The beneficial effect of OMT was insignificantly more pronounced in patients with male sex, older age, higher creatinine, lower DBP, and body mass index ≤25kg/m². OMT was more frequently achieved in patients with male sex independently of age, DBP, and creatinine. Achieving OMT was associated with less 5-point MACE independently of female sex, younger age, never smoking and NYHA ≤ 2. Background: Heart failure (HF) is a growing global health issue. Men and women experience HF differently in terms of causes, treatment, and outcomes. This study aimed to identify factors that predict whether patients receive optimal medical treatment (OMT) and to understand how OMT affects survival for men and women who participated in a heart failure clinical program (HFCP). Methods: The study analyzed 870 patients with heart failure and reduced heart function (LVEF &lt;40%) who completed the HFCP between 2018 and 2020. Patients were tracked for an average of about three years. OMT was defined as taking specific heart failure medications at least at 50% of the target doses. <b>Results:</b>Men were more likely than women to receive OMT, even after considering factors like age, blood pressure, and kidney function.Patients who received OMT had a lower risk of serious heart-related events regardless of sex, age, smoking history, or heart failure severity. Men were more likely than women to receive OMT, even after considering factors like age, blood pressure, and kidney function. Patients who received OMT had a lower risk of serious heart-related events regardless of sex, age, smoking history, or heart failure severity. Conclusion: Men were more likely than women to receive OMT, independent of other health factors. Receiving OMT was linked to better outcomes.