What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Heart Failure (n=50). Intervention: Heart failure with reduced ejection fraction (HFrEF) vs. Heart failure with preserved ejection fraction (HFpEF). Primary outcome: SGLT2 inhibitor prescription rate (Cramér's V 0.29, p=0.05).

What question did this study set out to answer?

This study aims to evaluate prescription patterns of guideline-directed medical therapies in patients with heart failure in an underserved population.

June 25, 2026Open Access

Gaps in Guideline-Directed Medical Therapy for Heart Failure: A Cross-Sectional Study in an Underserved Population

Key Result

Among underserved patients at a federally qualified health center, guideline-directed medical therapy was under-prescribed, with SGLT2 inhibitors prescribed to 34% of HFrEF and 0% of HFpEF patients.

Key Points

This study aims to evaluate prescription patterns of guideline-directed medical therapies in patients with heart failure in an underserved population.
Conducted a retrospective chart review of heart failure patients from May 2022 to June 2024.
Classified patients as HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) based on echocardiographic findings.
Compared baseline demographics and GDMT prescriptions between two HF diagnosis groups.
Fifty patients were identified: 41 with HFrEF and 9 with HFpEF.
Among HFrEF patients, 93% received beta-blockers, 83% received ACEi/ARB/ARNi, 29% received MRAs, and 34% received SGLT2 inhibitors.
0% of HFpEF patients were prescribed SGLT2 medications (p=0.05 compared to HFrEF).

Study Design

Type

Cross-Sectional (n=50)

Multicenter

Structured PICO

What are the prescription rates of guideline-directed medical therapy in an underserved heart failure population at a federally qualified health center?

Population

50 adults aged 18 to 80 years with heart failure receiving care at an urban federally qualified health center, predominantly uninsured or low-income.

Exposure

Guideline-directed medical therapy (GDMT) prescription, including beta-blockers, ACEi/ARB/ARNi, MRAs, and SGLT2 inhibitors.

Outcome

Prescription rates of GDMT among patients with heart failure.

Guideline-directed medical therapy, particularly MRAs and SGLT2 inhibitors, remains substantially under-prescribed in underserved, low-income heart failure populations at federally qualified health centers.

Main Result

Effect estimate: Cramér's V 0.29

Absolute Event Rate: 34% vs 0%

p-value: p=0.05

Limitations

Small sample size, particularly in the HFpEF group (n=9), limiting statistical power.
Considerable imbalance between groups (n=9 HFpEF vs. n=41 HFrEF) may introduce selection bias.
Cross-sectional design cannot demonstrate causality or account for potential confounders.
Did not systematically assess for contraindications to GDMT, which may overestimate the true gap in guideline-directed therapy.
Single-center study conducted at one urban FQHC limits generalizability.
Did not evaluate whether medications were prescribed at target doses or patient adherence.

Abstract

Background: Heart failure (HF) remains a major clinical and public health challenge. Guideline-directed medical therapy (GDMT) has been shown to improve outcomes in patients with HF; however, gaps in the prescription and implementation of these therapies persist. These treatment gaps may contribute to suboptimal disease management and adverse clinical outcomes, highlighting the need to better understand patterns of GDMT utilization in diverse patient populations. In this study, we assessed and evaluated the prescribing patterns of GDMTs to an underserved population at an urban federally qualified health center (FQHC). Methods: We conducted a retrospective chart review of patients diagnosed with HF from May 2022 to June 2024 to assess the prescription of GDMT. Patients were classified based on echocardiographic findings as HF with reduced ejection fraction (HFrEF) (< 50%) and HF with preserved ejection fraction (HFpEF) (≥ 50%). Baseline demographics and prescription of GDMTs were compared between the two HF diagnoses. Results: Fifty patients with HF were identified in the study period, including 41 with HFrEF and nine with HFpEF. There was a significant difference in the mean age between patients diagnosed with HFpEF (68 years) as compared to patients with HFrEF (58 years) (p=0.02). Among patients with HFrEF, 93% (n=38) were prescribed beta-blockers (BB), 83% (n=34) were prescribed angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNi), 29% (n=12) were prescribed mineralocorticoid receptor antagonists (MRA), and 34% (n=14) were prescribed sodium-glucose cotransporter-2 inhibitors (SGLT2). Prescriptions for these medical therapies were similar among patients with HFpEF, except that 0% were prescribed an SGLT2 medication (p=0.05 for comparison with patients with HFrEF). Conclusions: GDMT is under-prescribed in underserved populations, underscoring the need for specific interventions to address financial, systemic, and educational barriers. Interventions such as patient education initiatives, financial counseling support, provider training programs, and policy changes to improve medication affordability and access should be prioritized to help close these treatment gaps.

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