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Background and Aims: Heart failure with preserved ejection fraction (HFpEF) is an increasingly common clinical syndrome, estimated to constitute approximately 50 % of all heart failure (HF) cases. Nonetheless, registries from specific geographic areas, as Latin America, are lacking. The present study aims to report the underlying causes, comorbidities, treatment patterns and outcomes of patients with HFpEF in a large cardiovascular center in Mexico City., Methods: The present is a prospective, longitudinal, observational study, including female and male patients over 18 years of age, who presented to the emergency department, coronary care unit or outpatient department of the National Institute of Cardiology Ignacio Chavez in Mexico City with HFpEF. Patients were classified according to different phenotypes and current literature. The primary outcome was the composite total HFpEF hospitalization and all-cause mortality., Results: Within a median follow-up of 472 (IQR 425-518) days, total mortality was 14.56 %, with 10.68 % attributed to cardiovascular causes. HF hospitalization was 7.77 %. Atrial fibrillation showed a notable association with outcomes (adjusted HR 2.87, P = 0.028). Beta-blocker showed a non-significant trend towards benefit, while mineralocorticoid receptor antagonists (MRA) significantly influenced outcomes (adjusted HR 3.30, P = 0.018). The primary composite endpoint occurred in 19.42 % of patients, with no significant difference among phenotypes (P = 0.536)., Conclusions: We observed a substantial comorbidity burden impacting quality of life, as indicated by KCCQ scores. There was a high incidence of hard endpoints, including cardiovascular death and hospitalizations, alongside significant variability in treatment utilization. Future research should focus on elucidating individual healthcare trajectories in HFpEF patients and promoting wider adoption of evidence-based therapies., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: this work was supported by a research grant from Novartis [grant number IIT - CLCZ696AMX01T]. The sponsor did not participate in the enrolment or conduction of the study, nor in the final analysis or in the writing and approval of the present study. Diego Araiza Garaygordibil: reports speaking fees for Abbott, Asofarma, Astra Zeneca, Boehringer Ingelheim, Bayer, Lundbeck, Novartis, Novo Nordisk, Silanes, Servier. Advisory board: Silanes, Servier, Novartis, Novo Nordisk. Research grants: Novartis, Novo Nordisk. Rodrigo Gopar Nieto: reports speaking fees for Novartis and Asofarma. Daniel Sierra-Lara: reports speaking fees from Bayer, Novartis and Novo Nordisk. Alexandra Arias Mendoza: reports speaker fees from Asofarma, Astra Zeneca, Boehringer Ingelheim, Bayer, Novartis, Novo Nordisk., (© 2024 Published by Elsevier Inc.)

Introduction: In developing countries, there is a notable scarcity of real-world data on adherence to optimal medical therapy (OMT) and its correlation with major cardiovascular adverse events (MACEs) after ST-elevation myocardial infarction (STEMI). Our study focuses on addressing this gap by evaluating adherence to OMT, examining its influence on the risk of MACEs after STEMI, and assessing subsequent cardiovascular risk factor control in Mexico., Methods: We conducted a prospective observational study of post-STEMI patients after hospital discharge. Adherence to treatment was assessed over a median of 683 days (interquartile range: 478-833) using the Simplified Medication Adherence Questionnaire (SMAQ). Patients were followed up for 4.5 years to monitor MACEs (cardiovascular death, cardiogenic shock, recurrent myocardial infarction, and heart failure)., Results: We included 349 patients with a mean age of 58.08 years (±10.9), predominantly male (89.9%). Hypertension (42.4%), smoking (34.3%), type 2 diabetes mellitus (31.2%), obesity (22.92%), and dyslipidemia (21.4%) were highly prevalent. Adherence to OMT per SMAQ was 44.7%. The baseline clinical characteristics of adherent and non-adherent patients did not significantly differ. OMT prescription rates were as follows: acetylsalicylic acid, 91.1%; P2Y12 inhibitors, 76.5%; and high-intensity statins, 86.6%. While non-adherent patients had a numerically higher rate of MACEs (73 vs. 49 first events), there was no statistically significant difference (hazard ratio 1.30, 95% confidence interval 0.90-1.88)., Discussion: In this real-world study of patients after STEMI, we observed low adherence to OMT, a low proportion of global cardiovascular risk factor control, and a numerically higher incidence of recurrent major adverse cardiovascular events in non-adherent patients. Strategies to improve adherence to OMT and risk factor control are needed., Competing Interests: AA-M reports speaking fees with Astra Zeneca, Pfizer, Novartis, and Asofarma and research fees with Novoa Nordisk and MSD. RG-N reports speaking fees with Novartis and Asofarma. DA-G reports speaking fees for Abbot, Asofarma, Astra Zeneca, Boehringer Ingelheim, Novartis, Silanes, Servier, Novo Nordisk, and Lundbeck and research grants from Novartis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Villalobos-Pedroza, Hernandez-Pastrana, Arias-Mendoza, Latapi-Ruiz Esparza, Robles-Ledesma, Guerrero-Ochoa, Milanes-Gonzalez, Solis-Jimenez, Sierra Gonzalez-De Cossio, Flores-Batres, Brindis-Aranda, Rivera-Pedrote, Jara-Nevarez, Gonzalez-Macedo, Gopar-Nieto, Gonzalez-Pacheco, Briseño-De la Cruz and Araiza Garaygordobil.)