Ischemic heart disease (IHD) is still the leading cause of morbidity and mortality in the world, impacting healthcare systems and quality of life, especially in low- and middle-income countries (LMICs).1 Despite advancements in pharmacological therapies and clinical management, significant disparities persist in the implementation of evidence-based strategies, particularly in resource-limited settings.2,3 Those regions with suboptimal metabolic control and inadequate management of cardiovascular risk factors have more adverse outcomes like recurrent cardiovascular events, hospitalization and mortality.4,5 Additionally, chronic diseases continue to be one of the leading causes of disease burden, and cardiovascular risk factors tend to become more prevalent.6 In previous publications, the majority of patients – 90%- with heart failure (HF) have at least one comorbidity. Considering this, it is important to ensure adequate metabolic control.7

Evidence has demonstrated that pharmacological therapies like statins, ACE inhibitors (ACEIs), angiotensin receptor-neprilysin inhibitors (ARNIs), and beta-blockers significantly improve cardiovascular outcomes like reduced mortality, hospital admissions and enhance quality of life.2,4,8,9 However, barriers related to access, adherence, patient education, medication dosage and healthcare infrastructure often prevent these therapies from being implemented optimally.10, 11, 12

The evidence is clear that non-adherence to drug therapy increases the risk of acute decompensation of HF.13 In Latin America, the AMERICCAASS registry revealed that suboptimal pharmacologic therapy is still evident, where only 21.7% of the patients received the optimal medical therapy for the management of HF.14

In Colombia, despite attempts to standardize pharmacological therapy and improve clinical outcomes, data regarding metabolic control and pharmacological management of IHD remain limited, mainly in relation to adherence to international guidelines.3

Clinical evidence derived from some clinical trials, such as PARADIGM-HF and ESCHF Pilot, have shown disparity in the administration of drug therapy, with less administration of statins and ARNIs in certain subgroups of patients.2,4 Similarly, the ADHERE registry demonstrated how comorbidities such as diabetes mellitus and chronic kidney disease (CKD) significantly impact therapeutic decisions and patient outcomes.3 On the other hand, other studies have shown that patients with diabetes and HF more often received therapies such as beta-blockers, RAS inhibitors and mineralocorticoid receptor antagonist (MRA) compared to patients without diabetes.15

The aim of this study was to determine the deficiencies in the Colombian population in relation to the control and treatment of cardiovascular risk factors in patients with IHD enrolled in RECOLFACA. There have been previous publications on this registry where a detailed description of the demographic and clinical characteristics of these patients is made.16 Additionally, other studies have identified low proportions of device implementation and under-prescription of some of the medications used.17,18 We aim to analyze the utilization of key pharmacological therapies, including statins, ACEIs, and ARNIs, and identify factors associated with their suboptimal prescription and usage patterns.

Our hypothesis is that there are significant gaps in the pharmacological management of IHD in Colombia, influenced by a combination of sociodemographic factors, health care access barriers and variability in clinical practice.

Through this analysis, we aim to generate evidence-based insights that can inform healthcare policies, resource allocation strategies, and clinical guidelines, ultimately contributing to better cardiovascular outcomes and improved quality of life for patients with heart failure in Colombia.