SGLT2i use linked to lower adherence and QOL in HF patients in cross-sectional MTAC study

Guideline-directed medical therapy (GDMT) and newer agents such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) have significantly improved outcomes in heart failure (HF). However, their impact on patient experience—including medication adherence, treatment burden, and quality of life (QOL)—remains less understood in Malaysia, especially in structured outpatient settings such as Medication Therapy Adherence Clinic (MTAC). To evaluate associations between therapeutic intensity (full GDMT, SGLT2i use, and medication load) and patient-reported outcomes (PROs) in HF patients enrolled in an MTAC program. A cross-sectional study was conducted among 78 HF patients at a secondary hospital MTAC in Shah Alam, Malaysia. PROs were assessed using the Malaysia Medication Adherence Assessment Tool (MyMAAT-12), the Treatment Burden Questionnaire (TBQ), and WHOQOL-BREF. Full GDMT was defined as concurrent use of a RAAS inhibitor, beta blocker, MRA, and SGLT2i. Group comparisons were performed using Mann–Whitney U tests, and associations between medication load and PROs were assessed using Spearman correlation. The mean age of patients was 57.3 ± 11.5 years; 74.4% were male. Most were on polypharmacy (mean medication classes: 6.6 ± 1.2); 64.1% were on full GDMT and 82.1% were prescribed SGLT2i. Median adherence, burden, and QOL scores were 47.0 (IQR: 40.0–53.0), 39.0 (IQR: 24.0–58.0), and 88.0 (IQR: 77.0–98.0), respectively. Patients on full GDMT or ARNI had similar adherence, burden, and QOL scores compared to those not on these therapies. However, SGLT2i users reported significantly lower adherence (p = 0.037) and QOL (p = 0.018). Medication load was positively correlated with QOL (r = 0.295, p = 0.009), but not with adherence or burden. In this MTAC-supported cohort, polypharmacy and full GDMT were not associated with increased burden or reduced adherence. A modest positive association between medication count and QOL was observed. SGLT2i use was associated with lower adherence and QOL, although these findings are exploratory and may reflect differences in disease severity or treatment complexity rather than a direct effect of therapy. Overall, these results provide observational insights into the relationship between therapeutic intensity and PROs within a pharmacist-led care setting, and warrant confirmation in larger, longitudinal studies with appropriate adjustment for clinical variables.