Abstract Body (Do not enter title and authors here): Introduction: Heart failure (HF) is a global health burden, with disproportionately higher mortality rates in low and low-middle income countries (LIC/LMIC). Despite advances in guideline-directed medical therapy (GDMT), its accessibility and affordability remain major challenges, particularly in developing countries such as Venezuela.

Methods: This study aimed to assess the price and affordability of GDMT for HF in Venezuela. Prices of GDMT medications were obtained from leading pharmacies across the nation, and salary data retrieved from Observatorio Venezolano de Finanzas (OVF). Prices were adjusted to represent a standardized 30-day supply at GDMT target dosages. Affordability was assessed by comparing medication costs to monthly salaries across different employment categories.

Results: The study revealed substantial barriers to accessing GDMT in Venezuela, with prices of certain medications representing a significant percentage of monthly salaries. The cost of Angiotensin Receptor-Neprilysin Inhibitors (ARNI) alone consumes nearly 80% of the income for individuals in managing positions, rendering it almost inaccessible. Moreover, those earning minimum wages would struggle to afford any type of GDMT combination. (Table 1)

Discussion: These findings underscore the economic disparities in accessing GDMT for HF in Venezuela, reflecting broader challenges in LIC/LMICs. Comparison with similar studies in other countries highlights the global issue of medication affordability and availability. Addressing these barriers is crucial to improving HF outcomes and reducing disparities in healthcare access. Furthermore, there is a pressing need for comprehensive epidemiological data and national registries to inform policy decisions and optimize HF management strategies in Venezuela.

Conclusion: The study highlights the critical need for interventions to address the cost-related barriers to GDMT access for HF patients in Venezuela. Efforts to improve affordability and availability of essential medications are essential to ensure equitable access to life-saving therapies and reduce the burden of HF in developing countries.