Introduction

Heart failure (HF) is a global public health problem. In Latin America (LA), most of the epidemiology of HF relies on data from Europe and North America. However, its prevalence is estimated to be around 1%, and it is expected to increase in the following years [1]. Still, the magnitude of the burden of disease of HF cannot be assessed with precision because reliable population-based studies are lacking.

Early post-discharge mortality and readmission rates remain high, and many patients have poor long-term survival, even with contemporary management and available pharmacological treatments [2, 3]. A worse prognosis can occur in Latin American countries, as there are differences in HF severity, etiology, and management, potentially leading to substantial differences in health outcomes. Previous research has reported that South American patients had higher overall mortality than other world regions [4].

In Colombia, HF is also a public health concern of particular importance. The country faces many of the risk factors seen in developed countries and a high prevalence of Chagas disease, which contributes significantly to the national burden of cardiovascular disease [5]. Additionally, there is disparity in the distribution of healthcare services in the different regions of Colombia [6]. Even though healthcare coverage in Colombia for 2019 was 95% ensured either by the contributive regime (includes mandatory payments from employers) or by subsidized regime (set up initially for people outside the formal sector and with very low income) [7], in regions such as Orinoco or Amazonas, health coverage falls under 70% [8, 9]. Despite the fact that HF medication is guaranteed in the health benefit program [10], information regarding the health resource utilization associated with this condition in Colombia is scarce, and there is little evidence related to the epidemiology of HF in Colombia [11, 12]. That is why a national HF registry can provide valuable epidemiological data. Moreover, it can contribute to a better understanding of this syndrome and its local management.

This study aimed to fill the existing evidence gap by describing the demographic, clinical characteristics, QoL, and healthcare resource utilization patterns of chronic HF patients from the RECOLFACA registry, including 60 hospitals in 29 different Colombian cities. To our knowledge, RECOLFACA is the largest registry in Colombia, which provides valued epidemiological evidence and uncovers the current clinical practice for HF management in Colombia.

Methods Design

We conducted a retrospective observational study using data from 2016 to 2020 from the RECOLFACA registry. The division of Heart Failure, Pulmonary Hypertension and Heart Transplant of the Colombian Cardiology Society (SCC, Sociedad Colombiana de Cardiología y Cirugía Cardiovascular) created this registry. Researchers collected and consolidated the data in an online platform (INFAMED) available in each institution. The study received ethical approval from the Fundación Valle del Lili IRB (Comité de Ética en Investigación Biomédica IRB), and patients gave their written informed consent to participate at enrollment.

Data source, data quality control, and statistical considerations

The RECOLFACA database is a registry of 2,528 patients with HF and more than 90 variables measured. It was created in 2016 and consisted of two phases of data collection: In the first phase (phase I, 2016–2018), 20 institutions in 11 Colombian cities participated in the recruitment process, whereas in the second phase (phase II: 2018–2020), 40 additional institutions from 18 additional cities joined the registry to assure representation of the five Colombian regions. The registry collected data from patients at two moments: At baseline, that is, when they were enrolled, and six months later, as a follow-up. The registry includes sociodemographic information, medical history, information regarding in-patient visits, medication use, etiology of HF (determined by primary physician), assessment of HF, treatment for HF at baseline and follow-up, clinical outcomes at follow-up (decompensation, EKG, %LVEF, biochemical markers), and quality of life (QoL) assessment. For this last variable, the EQ-5D-3L questionnaire, which measures patients’ mobility, ability to self-care, ability to carry out usual activities, grade of pain or discomfort, and presence of anxiety or depression [13], was used due to it being preferred by physicians in Colombia and its availability in the databases.

This study included adult patients (≥18 years old) with a history of hospital admission due to heart failure during the 12 months prior to study baseline who were currently attending cardiology or heart failure–related medical consultations at a healthcare institution participating in the RECOLFACA registry. Patients who had a history of cardiac transplant or were on a cardiac transplant waiting list were excluded. Likewise, patients who had a history of ventricular assistance device (VAD) implantation, who were on a waiting list for VAD implantation, or who had a neurological or social disability that would limit the follow-up were not eligible for the study.

This database was set and cleaned using R Statistical Software [14], ensuring adherence to all local and regional laws on data protection and privacy. We conducted the statistical analyses after checking the data set for quality issues and missing variables. We included only patients with available data at baseline and the six-month follow-up. Furthermore, patients with missing data for relevant variables, such as gender and age, and for clinical characteristics at baseline, such as left ventricular ejection fraction (LVEF), stage of heart failure, and NYHA functional classification, were excluded from the analyses. No data imputation for variables with null values was conducted.

We described all variables according to their type. We employed frequencies and proportions for categorical variables, and we used central tendency statistics (mean, median) and dispersion measures (variance, standard deviation) for continuous variables. Analysis of change from baseline was performed for clinical outcomes. All statistical analyses were conducted using R Statistical Software [14]. The study was conducted in accordance with the revised guidelines of the World Medical Association Declaration of Helsinki and local laws and regulations.

Results Demographic characteristics

Our analysis included 2,045 patients from this registry from Colombia who met the eligibility criteria. Table 1 and Figure 1 show an overview of the demographic characteristics of the patients. The mean age of the population was 67.71 ± 13.64 years, with patients from the Orinoco region being younger than patients from the rest of the country (57.25 ± 11.53). The patient population mainly included males (57.2%). Most patients in the registry had a mixed race or ethnic background. In the Pacific region, a higher proportion of the population was black (13.4%), while 6% of the Amazon and Pacific regions were indigenous.

Table 1

Demographic characteristics of patients from the RECOLFACA registry at baseline.

AGE (YEARS) COLOMBIA ANDEAN PACIFIC ORINOCO CARIBBEAN AMAZON Mean ± SD 67.71 ± 13.64 68.84 ± 12.92 66.73 ± 14.53 57.25 ± 11.53 65.80 ± 14.01 67.70 ± 14.67     Gender N (%)     Female 875 (42.8) 481 (42.5) 122 (36.4) 7 (43.8) 199 (49.1) 66 (42.0)     Male 1,170 (57.2) 651 (57.5) 213 (63.6) 9 (56.2) 206 (50.9) 91 (58.0) Race N (%)     Mixed 1,884 (92.1) 1,075 (95.0) 265 (79.1) 16 (100.0) 381 (94.1) 147 (93.6)   White 91 (4.4) 51 (4.5) 19 (5.7) 0 (0.0) 12 (3.0) 9 (5.7)   Black 60 (2.9) 3 (0.3) 45 (13.4) 0 (0.0) 12 (3.0) 0 (0.0)   Indigenous 9 (0.4) 2 (0.2) 6 (1.8) 0 (0.0) 0 (0.0) 1 (0.6)   Asian 1 (0.0) 1 (0.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Schooling N (%)   Basic primary school 782 (38.2) 448 (39.6) 141 (42.1) 6 (37.5) 128 (31.6) 59 (37.6)   High school 558 (27.3) 308 (27.2) 105 (31.3) 6 (37.5) 110 (27.2) 29 (18.5)   None 385 (18.8) 173 (15.3) 31 (9.3) 2 (12.5) 118 (29.1) 61 (38.9)   Technical/technological education 150 (7.3) 84 (7.4) 37 (11.0) 1 (6.2) 26 (6.4) 2 (1.3)   University/professional education 147 (7.2) 106 (9.4) 15 (4.5) 1 (6.2) 19 (4.7) 6 (3.8)   Postgraduate education 23 (1.1) 13 (1.1) 6 (1.8) 0 (0.0) 4 (1.0) 0 (0.0) Type of health insurance N (%)   Contributory 1,182 (57.8) 713 (63.0) 260 (77.6) 8 (50.0) 130 (32.1) 71 (45.2)   Subsidized 733 (35.8) 316 (27.9) 55 (16.4) 7 (43.8) 273 (67.4) 82 (52.2)   Additional health insurance policy 130 (6.4) 103 (9.1) 20 (6.0) 1 (6.2) 2 (0.5) 4 (2.5) Zone N (%)   Rural 560 (27.4) 308 (27.2) 64 (19.1) 6 (37.5) 135 (33.3) 47 (29.9)   Urban 1,485 (72.6) 824 (72.8) 271 (80.9) 10 (62.5) 270 (66.7) 110 (70.1) Figure 1 

Demographic characteristics of patients from the RECOLFACA registry.

The results show that most of the population had low education levels, with 38.2% having only reached basic primary school and 18.8% having no formal education. The proportion of patients from the registry living in urban areas was high (72.6%), and more than half of the patients (57.8%) were enrolled in the national contributive insurance scheme.

Heart failure etiology

The most common etiology of HF was ischemic heart disease (43.9%), followed by hypertensive heart disease (32.0%) and valvular disease (12.7%). Chagas disease was reported in 3.4% of the patients. A higher proportion of patients from the Andean region had been diagnosed with this disease (53 patients). Figure 2 shows the different HF etiologies of patients from the RECOLFACA registry.

Figure 2 

Etiology of heart failure.

Comorbidities

The most frequent associated comorbidities found in patients from the registry were hypertension (72.2%), followed by diabetes (27.1%), and dyslipidemia (26.9%).

Hospital admission history

In agreement with the inclusion criteria, all patients required at least one prior hospitalization to be included in the registry. The most common cause of hospitalization was, exclusively, acute heart failure (80.3%) (Table 2).

Table 2

Hospital admission history.

HOSPITAL ADMISSION HISTORY BASELINE (LAST YEAR) N = 2,045 6-MONTH FOLLOW-UP (LAST 6 MONTHS) N = 1,907* COLOMBIA ANDEAN PACIFIC ORINOCO CARIBBEAN AMAZON COLOMBIA ANDEAN PACIFIC ORINOCO CARIBBEAN AMAZON Due to heart failure N (%) 2,045 (100.0) 1,132 (100.0) 335 (100.0) 16 (100.0) 405 (100.0) 157 (100.0) 462 (24.2) 231 (22.1) 82 (25.9) 3 (18.8) 109 (28.3) 37 (25.9) Only due to HF N (%) 1,643 (80.3) 916 (80.9) 284 (84.8) 13 (81.2) 338 (83.5) 92 (58.6) 381 (20.0) 186 (17.8) 69 (21.8) 3 (18.8) 88 (22.9) 35 (24.5) Due to HF and other N (%) 402 (19.7) 216 (19.1) 51 (15.2) 3 (18.8) 67 (16.5) 65 (41.4) 81 (4.25) 45 (4.3) 13 (4.1) 2 (1.4) 21 (5.5) 2 (1.4) Missing data N (%) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1,445 (75.8) 815 (77.9) 235 (74.1) 106 (74.1) 276 (71.7) 13 (81.3) NUMBER OF HF-RELATED HOSPITALIZATIONS COLOMBIA ANDEAN PACIFIC ORINOCO CARIBBEAN AMAZON COLOMBIA ANDEAN PACIFIC ORINOCO CARIBBEAN AMAZON Mean ± SD 1.4 ± 1.1 1.3 ± 0.8 1.5 ± 1.3 1.3 ± 1.0 1.6 ± 1.6 1.6 ± 1.3 1.7 ± 2.1 1.8 ± 2.7 1.6 ± 1.4 1.0 ± 0.0 1.6 ± 1.1 1.9 ± 1.3 Missing data N (%) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1,446 (75.8) 816 (78) 235 (74.1) 13 (81.3) 276 (71.7) 106 (74.1) LOS IN HOSPITALIZATION COLOMBIA ANDEAN PACIFIC ORINOCO CARIBBEAN AMAZON COLOMBIA ANDEAN PACIFIC ORINOCO CARIBBEAN AMAZON Mean ± SD 11.2 ± 12.6 11.7 ± 11.1 11.7 ± 16.3 9.6 ± 7.1 10.3 ± 9.1 9.0 ± 18.3 10.7 ± 9.9 12.3 ± 10.9 9.5 ± 11.8 20.3 ± 12.4 9.5 ± 5.5 8.6 ± 9.4 Missing data N (%) 859 (42) 496 (43.8) 105 (31.3) 7 (43.8) 179 (44.2) 72 (45.9) 1,644 (86.2) 929 (88.8) 274 (86.4) 13 (81.3) 321 (83.4) 107 (74.8)

HF: heart failure; LOS: length of stay.

* Percentages were calculated over the total population that remained alive at the 6-month follow-up.

A year prior to entering the registry, patients were hospitalized an average of 1.4 ± 1.1 times (length of hospital stay of 11.2 ± 12.6 days). At the six-month follow-up, patients had an average of 1.7 ± 2.1 hospitalizations (length of hospital stay of 10.7 ± 9.9 days). Missing data were significant at follow-up for the number of readmissions and the length of hospital stay. Table 2 presents details of hospitalization history at baseline and follow-up.

Clinical characteristics and outcomes

Based on the New York Heart Association (NYHA) Functional Classification, at baseline, 53.4% of the patients had mild symptoms and slight limitations for ordinary activities (class II), 29.8% of the patients suffered from marked limitations due to symptoms even during less-than-ordinary activity (class III), and 4.8% of the patients were only comfortable at rest (class IV). Twelve percent of the patients had no symptoms and no limitations in ordinary physical activity (class I). As shown in Figure 3, at the six-month follow-up, the functional class of 27.4% of patients improved, while 10.3% worsened NYHA classification.

Figure 3 

Changes in functional class according to NYHA at baseline.

The average LVEF was 34.2 ± 13.5 at baseline, with 73.6% of the patients having a LVEF ≤40% (heart failure with a reduced ejection fraction, HFrEF). At the six-month follow-up, the average LVEF was 36.7 ± 13.8, and 65.7% of the patients with available ejection fraction at follow-up had HFrEF. Table 3 includes other clinical variables measured at baseline and follow-up, including the American College of Cardiology (ACC) and the American Heart Association (AHA) HF classification and brain natriuretic peptides (BNP/NT pro BNP). Other paraclinical studies are included in Supplementary Table 1.

Table 3

Clinical outcomes for patients from the RECOLFACA registry.

BASELINE (N = 2,045) 6-MONTH FOLLOW-UP (N = 1,907*) COLOMBIA ANDEAN PACIFIC ORINOCO CARIBBEAN AMAZON COLOMBIA ANDEAN PACIFIC ORINOCO CARIBBEAN AMAZON NYHA classification; N (%)Class I 245 (12.0) 146 (12.9) 53 (15.8) 3 (18.8) 41 (10.1) 2 (1.3) 386 (20.24) 217 (20.75) 95 (29.97) 4 (25) 43 (11.17) 27 (18.88) Class II 1,092 (53.4) 602 (53.2) 175 (52.2) 12 (75.0) 230 (56.8) 73 (46.5) 941 (49.34) 559 (53.44) 105 (33.12) 3 (18.75) 210 (54.55) 64 (44.76) Class III 609 (29.8) 347 (30.7) 84 (25.1) 1 (6.2) 124 (30.6) 53 (33.8) 262 (13.74) 140 (13.38) 47 (14.83) 3 (18.75) 53 (13.77) 19 (13.29) Class IV 99 (4.8) 37 (3.3) 23 (6.9) 0 (0.0) 10 (2.5) 29 (18.5) 42 (2.2) 14 (1.34) 8 (2.52) 0 (0) 8 (2.08) 12 (8.39) Missing data 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 276 (14.47) 116 (11.09) 62 (19.56) 6 (37.5) 71 (18.44) 21 (14.69) ACA/AHA Failure Stages; n (%)Stage C 1,946 (95.2) 1,092 (96.5) 304 (90.7) 16 (100.0) 385 (95.1) 149 (94.9) 1,308 (68.59) 817 (78.11) 207 (65.3) 4 (25) 43 (11.17) 27 (18.88) Stage D 99 (4.8) 40 (3.5) 31 (9.3) 0 (0) 20 (4.9) 8 (5.1) 97 (5.09) 42 (4.02) 26 (8.2) 3 (18.75) 210 (54.55) 64 (44.76) Missing data 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 226 (11.85) 71 (6.79) 22 (6.94) 3 (18.75) 53 (13.77) 19 (13.29) % LEVFMean ± SD 34.2 ± 13.5 34.4 ± 4.2 31.1 ± 12.5 31.9 ± 14.7 33.1 ± 10.9 42.4 ±12.7 36.7 ±13.8 37.5 ± 14.4 32.8 ± 13.0 41.0 ± 22.9 34.9 ± 11.1 43.7 ± 13.8 Missing data; N (%) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1,144 (59.99) 583 (55.74) 202 (63.72) 13 (81.25) 244 (63.38) 102 (71.33) NT-pro BNP (pg/mL)Mean ± SD 5,514.0 ± 8,360.7 5,711.9 ± 8,461.4 6,146.6 ± 8,631.1 3,141.7 ± 3,362.7 5,128.4 ± 8,299.6 2,702.5 ± 2,717.4 3,625.4 ± 6,638.4 4,017.2 ± 8,893.5 6,472.3 ± 8,121.5 2,969.5 ± 3,278.9 2,874.9 ± 3,905.3 487.3 ± 504.2 Missing data; N (%) 1,680 (82.2) 963 (85.1) 283 (84.5) 13 (81.3) 266 (65.7) 155 (98.7) 1,703 (89.3) 972 (92.93) 296 (93.38) 14 (87.5) 281 (72.99) 140 (97.9) BNP (pg/mL)Mean ± SD 1,616.8 ± 2,232.7 1,593.3 ± 2,312.0 1,386.2 ± 1,222.7 1,097.5 ± 1,450.3 2,179.1 ± 1,745.5 — 1,493.7 ± 2,214.3 1,484.0 ± 2,258.5 8,88.7 ± 1,217.2 23.0 ± nan 3,119.0 ± 2,340.4 560.9 ± nan Missing data; N (%) 1,907 (93.3) 1,010 (89.2) 330 (87.5) 14 (87.5) 396 (97.8) 157 (100) 1,832 (96.07) 979 (93.59) 314 (99.05) 15 (93.75) 382 (99.22) 142 (99.3)

* Percentages were calculated over the total population that remained alive at the 6-month follow-up.

Mortality

As shown in Table 4, the mortality rate was 6.7%, with patients from the Amazon region having the highest rate (8,8%). Most deaths in the registry were cardiovascular deaths (74.6%), with a mean time from recruitment to death of 149.6 ± 128.3 days. By HF etiology, chemotherapy had the highest mortality frequency (25%), followed by toxic (15.8%), Chagas disease (10%), valvular disease (8.4%), and hypertension (7.6%).

Table 4

Mortality at six-month follow-up of patients from the RECOLFACA registry.

COLOMBIA ANDEAN PACIFIC ORINOCO CARIBBEAN AMAZON Mortality at 6-month follow-up; N (%) 138 (6.7) 86 (7.6) 18 (5.4) 0 (0.0) 20 (5.0) 14 (8.8) Cardiovascular deaths; N (%) 103 (74.6) 66 (76.7) 15 (83.3) 0 (0.0) 18 (90.0) 4 (28.6) Non-cardiovascular deaths; N (%) 35 (25.4) 20 (23.3) 3 (16.7) 0 (0.0) 2 (10.0) 10 (71.4) Mean days of follow-up from start date to death (Mean ± SD) 149.6 ± 128.3 142.7 ± 129.4 189.3 ± 164.3 0 (0.0) 124.8 ± 76.8 186.3 ± 135.1 Health-related quality of life

The average QoL score was measured using the EQ-5D-3L questionnaire. The results show a QoL of 78.7 ± 20.8 at baseline and of 82.3 ± 20.1 at the six-month follow-up, with a mean change from baseline of 10.0 ± 60.2. As shown in Table 5, changes from baseline were highly variable between regions, with the Amazon region showing a mean change from baseline of –10.7 ± 38.6 and the Andean region showing a mean change of 18.0 ± 73.3.

Table 5

Health-related quality of life score.

BASELINE MEAN ± SD 6-MONTH FOLLOW-UP MEAN ± SD MEAN CHANGE FROM BASELINE MISSING DATA (BASELINE) N (%) MISSING DATA (FOLLOW-UP) N (%) * Colombia 78.7 ± 20.8 82.3 ± 20.1 10.0 ± 60.2 0 (0) 279 (14.63) Andean 76.2 ± 21.7 83.6 ± 19.0 18.0 ± 73.3 0 (0) 118 (11.28) Pacific 82.7 ± 19.6 82.2 ± 21.2 2.3 ± 37.8 0 (0) 62 (19.56) Orinoco 84.4 ± 17.5 90.0 ± 15.6 4.8 ± 19.6 0 (0) 6 (37.5) Caribbean 82.6 ± 18.7 84.0 ± 17.8 0.8 ± 26.6 0 (0) 72 (18.7) Amazon 77.0 ± 19.9 68.1 ± 25.9 –10.7 ± 38.6 0 (0) 21 (14.69)

* Percentages were calculated over the total population that remained alive at the 6-month follow-up (N = 1,907).

Treatment patterns

Beta-blockers were the most extensively used therapeutic group at baseline (79% of patients), with carvedilol as the predominantly prescribed medication (63% of patients); see Table 6.

Table 6

Medication patterns—RECOLFACA registry.

MEDICATION CLASS BASELINE 6-MONTH FOLLOW-UP TOTAL
N = 2,045 HFREF
N = 1,506 LVEF >40%
N = 539 TOTAL
N = 1,629* HFREF
N = 501*** LVEF >40%
N = 262*** Beta-Blocker   Carvedilol; N (%) 1,295 (63.0) 1,019 (67.7) 276 (51.2) 1,065 (65.4) 321 (64.1) 151 (57.6)    Metoprolol Succinate; N (%) 311 (15.0) 209 (13.9) 102 (18.9) 278 (17.1) 95 (19) 55 (21)    Nebivolol; N (%) 21 (1.0) 13 (0.9) 8 (1.5) 19 (1.2) 5 (1) 3 (1.2) ARNI   Sacubitril/Valsartan; N (%) 203 (10.0) 187 (12.4) 16 (3) 281 (17.2) 121 (24.2) 30 (11.5) ACEi   Enalapril; N (%) 677 (33.0) 542 (36) 135 (25.1) 484 (29.7) 165 (32.9) 56 (21.4)    Captopril; N (%) 6 (0.0) 6 (0.4) – 3 (0.2) – 1 (0.49) ARB   Losartan; N (%) 745 (36.0) 503 (33.4) 242 (44.9) 554 (34) 138 (27.5) 104 (39.7)    Valsartan; N (%) 63 (3.0) 32 (2.1) 31 (5.8) 50 (3.1) 13 (2.6) 16 (6.1)    Candesartan; N (%) 46 (2.0) 30 (2) 16 (3) 34 (2.1) 7 (1.4) 14 (5.3) Diuretics   Furosemide; N (%) 1,315 (64.0) 1,033 (68.6) 282 (52.3) 1,018 (62.5) ** 341 (68.1) 118 (45)    Hydrochlorothiazide; N (%) 74 (4.0) 35 (2.3) 39 (7.2) 48 (2.9) ** 6 (1.2) 14 (5.3)    Indapamide; N (%) 5 (0.0) – 1 (25.0) 4 (0.2) ** – 1 (0.4) MRAs   Spironolactone; N (%) 1,091 (53.0) 949 (63) 142 (26.4) 933 (57.3) 336 (67.1) 99 (37.8)    Eplerenone; N (%) 65 (3.0) 52 (3.5) 13 (2.4) 70 (4.3) 27 (5.4) 15 (5.7) Other medication   Antiplatelet medication; N (%) 958 (46.8) 699 (46.4) 259 (48.1) 728 (44.7) 269 (53.7) 133 (64.6)    Statins; N (%) 1,128 (55.2) 817 (54.3) 311 (57.7) 961 (59) 319 (63.7) 184 (89.3)    Digoxin; N (%) 204 (10.0) 179 (11.9) 25 (4.6) 174 (10.7) 62 (12.4) 13 (5)    Ivabradine; N (%) 135 (7.0) 122 (8.1) 13 (2.4) 121 (7.4) 55 (11) 20 (7.6)    Nitrates; N (%) 83 (4.1) 60 (4.0) 23 (4.3) 51 (3.1) 17 (3.4) 8 (3.9)

HFrEF: heart failure with a reduced ejection fraction (≤40%).

* Patients with available data at follow-up;

** N = 1,628 at follow-up (Patients with available data for diuretic medication).

*** Patients with available ejection fraction at follow-up.

Regarding renin-angiotensin-aldosterone system (RAAS) inhibitors, a third of the patients received ACEi at baseline with enalapril as the most prescribed medication; 41% of patients received ARB group medications. There was a higher use of losartan than other medications of this therapeutic group. Ten percent of the patients received angiotensin receptor neprilysin inhibitor (ARNI) at baseline. In total, 85.2% of the patients were receiving some type of RAAS inhibitor (ACEi, ARB, or ARNI).

Mineralocorticoid receptor antagonists (MRA) were prescribed in 59% of the patients at baseline. Spironolactone was the most used medication of this type (1,091 patients). Of the patients who had a reduced ejection fraction (i.e., LVEF ≤40%), 74.6% were taking an MRA.

Of the patients with HFrEF classified as NYHA class I, 82.2% received some type of RAAS, while from the symptomatic (NYHA class II–IV) patients with HFrEF, 86.9% received a RAAS inhibitor, and 88.8% were prescribed a beta-blocker. Only 12.1% of patients with symptomatic HFrEF had been prescribed an ARNI at baseline. From the patients with HFrEF (NYHA class I–IV) 86.3% were receiving some type of RAAS.

Other therapeutic groups were present at baseline; the most relevant were statins and antiplatelet medication, in 52.2% and 46.8% of patients, respectively.

An implantable cardioverter-defibrillator was used by 11.3% of patients, while cardiac resynchronization treatment was used by 8.4% of patients who met criteria for received a device. Table 7 shows the usage of each type of implantable device at baseline.

Table 7

Implantable device use at baseline—RECOLFACA registry.

IMPLANTABLE DEVICE COLOMBIA ANDEAN PACIFIC CARIBBEAN AMAZON ORINOCO ICD; N (%) 181 (8.9) 134 (11.8) 24 (7.2) 10 (2.5) 12 (7.6) 1 (6.2) Dual chamber pacemaker; N (%) 80 (3.9) 54 (4.8) 14 (4.2) 8 (2.0) 4 (2.5) 0 (0) Single chamber pacemaker; N (%) 33 (1.6) 20 (1.8) 5 (1.5) 6 (1.5) 2 (1.3) 0 (0) CRT-D; N (%) 101 (4.9) 60 (5.3) 24 (7.2) 17 (4.2) 0 (0) 0 (0)