PLASMA Chile: A prospective, multicenter observational cohort study of patients with heart failure and reduced left ventricular ejection fraction.

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 beta-blockers (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 HF with reduced LVEF receive pharmacological therapy consistent with international standards; however, they face access barriers to CIEDs, which are underutilized despite their benefits.