Evolution of heart failure management in korea: a serial comparison of physician awareness and practice patterns (2019 vs. 2025)

초록

Background: To assess temporal changes in heart failure (HF) awareness and practice patterns among Korean physicians following major guideline updates and the emergence of contemporary guideline-directed medical therapy (GDMT). Methods: We performed a serial cross-sectional comparison of two physician surveys conducted in Korea in 2019 (KNOW-HF1; analytic n=471 after excluding incomplete responses) and 2025 (KNOW-HF2; n=236), including primary care physicians (PCPs) and cardiologists. We derived an Overall Awareness Score (0–7) based on the number of core HF concepts answered without "don’t know/missing". Results: Between 2019 and 2025, awareness improved in both groups, with larger gains in PCPs (mean score 6.18→6.63; p<0.001) than cardiologists (6.74→6.93; p<0.001). The proportion achieving a perfect score increased from 63.2% to 81.2% in PCPs and from 85.2% to 91.9% in cardiologists. "Don’t know" responses decreased for 1-year post-discharge mortality (8.5%→4.7%) and readmission (7.2%→5.5%). Among PCPs, diagnostic tool utilization increased, particularly BNP/NT-proBNP (58.0%→84.2%), with a smaller rise in echocardiography (Q62.1%→69.3%). Adoption of contemporary GDMT increased substantially: regular ARNI prescribing (≥25% of patients) rose from 17.5% to 92.6% among cardiologists and from 12.1% to 46.5% among PCPs. In 2025, SGLT2 inhibitor prescribing was widespread (regular use ≥25%: 91.1% cardiologists; 68.3% PCPs). The most frequent perceived barriers in 2025 included hypotension/renal concerns for ARNI and genitourinary infections/renal concerns for SGLT2 inhibitors. Conclusions: HF awareness and evidence-aligned practice patterns improved between 2019 and 2025, particularly among PCPs, alongside markedly increased uptake of contemporary GDMT. Persistent PCP–cardiologist gaps in diagnostic access and GDMT adoption highlight the need for continued education and system-level strategies.