What question did this study set out to answer?

To identify microeconomic, health policy, and administrative barriers to guideline-directed medical therapy (GDMT) optimization in heart failure with reduced ejection fraction (HFrEF) and propose actionable solutions.

August 30, 2026Heart Failure Reviews

Economic and policy barriers like cost sharing significantly limit optimal GDMT use in HFrEF.

Q: What is the clinical evidence from this study?

Study design: Review. Population: Heart failure with reduced ejection fraction (HFrEF). Intervention: Guideline-directed medical therapy (GDMT).

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Why the study?

Fewer than 25% of individuals with HFrEF receive all four pillars of GDMT, with underuse driven partly by economic and policy factors.

Design

Review

Key result

Economic and policy factors, including patient cost sharing, lack of price transparency, and administrative barriers, significantly limit the optimal use of guideline-directed medical therapy in HFrEF.

Authors

AMAustin J. Milton SCSpencer Carter RFRoberta Florido

Discussion

Member takes

Overview

Cost-sharing and administrative barriers may limit GDMT in HFrEF; leaves open the efficacy of policy reforms to enhance uptake.

Key Points

To identify microeconomic, health policy, and administrative barriers to guideline-directed medical therapy (GDMT) optimization in heart failure with reduced ejection fraction (HFrEF) and propose actionable solutions.
Reviewed publicly available microeconomic data, economic theory, and health policy literature concerning heart failure pharmacotherapy.
Assessed the impact of patient cost sharing, opaque drug pricing mechanisms, and administrative cost-containment tools on medication adherence and initiation.
Fewer than 25% of patients with HFrEF receive all four pillars of GDMT, driven significantly by high patient cost sharing, opaque rebate structures, and restrictive formulary barriers.
Identified that out-of-pocket costs drive nonadherence in economically vulnerable groups, while prior authorization requirements and formulary limitations delay or prevent initiation of high-value therapies.
Proposed reducing cost sharing, increasing price transparency, and streamlining administrative barriers to improve adherence and reduce heart failure hospitalizations.

Structured PICO

Population

Individuals with heart failure with reduced ejection fraction (HFrEF)

Intervention

Policy and clinician-level interventions to improve guideline-directed medical therapy (GDMT) adoption (reducing cost sharing, enhancing price transparency, reducing administrative barriers)

Addressing economic factors such as patient cost sharing, price transparency, and administrative barriers is essential for improving the population-level adoption of guideline-directed medical therapy in HFrEF.

Cite This Study

Milton et al. (2026) conducted a review in Heart failure with reduced ejection fraction (HFrEF). Guideline-directed medical therapy (GDMT) was evaluated. Economic and policy factors, including patient cost sharing, lack of price transparency, and administrative barriers, significantly limit the optimal use of guideline-directed medical therapy in HFrEF.

synapsesocial.com/papers/6a941eb16c1a8fb52e79e87e https://doi.org/10.1007/s10741-026-10670-y

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August 30, 2026Heart Failure Reviews

Economic and policy barriers like cost sharing significantly limit optimal GDMT use in HFrEF.

View Full Paper

Ask AI

Bookmark

Why the study?

Fewer than 25% of individuals with HFrEF receive all four pillars of GDMT, with underuse driven partly by economic and policy factors.

Design

Review

Key result

Authors

AMAustin J. Milton SCSpencer Carter RFRoberta Florido

Discussion

Member takes

Overview

Cost-sharing and administrative barriers may limit GDMT in HFrEF; leaves open the efficacy of policy reforms to enhance uptake.

Key Points

To identify microeconomic, health policy, and administrative barriers to guideline-directed medical therapy (GDMT) optimization in heart failure with reduced ejection fraction (HFrEF) and propose actionable solutions.
Reviewed publicly available microeconomic data, economic theory, and health policy literature concerning heart failure pharmacotherapy.
Assessed the impact of patient cost sharing, opaque drug pricing mechanisms, and administrative cost-containment tools on medication adherence and initiation.
Fewer than 25% of patients with HFrEF receive all four pillars of GDMT, driven significantly by high patient cost sharing, opaque rebate structures, and restrictive formulary barriers.
Identified that out-of-pocket costs drive nonadherence in economically vulnerable groups, while prior authorization requirements and formulary limitations delay or prevent initiation of high-value therapies.
Proposed reducing cost sharing, increasing price transparency, and streamlining administrative barriers to improve adherence and reduce heart failure hospitalizations.

Structured PICO

Population

Individuals with heart failure with reduced ejection fraction (HFrEF)

Intervention

Policy and clinician-level interventions to improve guideline-directed medical therapy (GDMT) adoption (reducing cost sharing, enhancing price transparency, reducing administrative barriers)

Cite This Study

synapsesocial.com/papers/6a941eb16c1a8fb52e79e87e https://doi.org/10.1007/s10741-026-10670-y

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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