Hospital participation in the GWTG-HF program was associated with a significantly higher 90-day post-discharge guideline-directed medical therapy score (+0.15 points) compared to non-participating hospitals.
Observational (n=1,274,863)
Yes
Does hospital participation in the GWTG-HF registry improve GDMT prescription scores and clinical outcomes in Medicare beneficiaries hospitalized for HFrEF?
Hospital participation in the GWTG-HF quality improvement registry is associated with modest but significant improvements in GDMT prescription intensity and reduced short-term mortality for HFrEF patients.
Mean Difference: 0.15 (95% CI 0.12–0.18)
Absolute Event Rate: 4.5% vs 4%
p-value: p=<0.001
Abstract Purpose Despite strong evidence, real-world adoption of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains suboptimal. The Get With The Guidelines–Heart Failure (GWTG-HF) program was designed to close gaps in care. We evaluated whether hospital participation in GWTG-HF is associated with greater GDMT intensity and improved outcomes. Methods We conducted a retrospective analysis (2013-2021) of Medicare beneficiaries with Part A and Part D hospitalized with HFrEF. Using a multiple baseline time series design, we compared changes in GDMT prescribing and outcomes at hospitals before and after GWTG-HF enrollment with hospitals that never participated. The primary outcome was a 90-day post-discharge prescription-fill GDMT score summarizing use and dose of beta blockers, renin-angiotensin system inhibitors (RASI; ACE inhibitor/ARB/ARNI), and mineralocorticoid receptor antagonists (MRA). Secondary outcomes included class-specific medication fills, achievement of ≥50% target doses, and 30-day, 90-day, and 1-year all-cause and HF readmission and mortality. We adjusted for baseline hospital performance, patient characteristics, and temporal trends. Results Among 1,274,863 Medicare beneficiaries hospitalized for HFrEF, 53.5% were treated at hospitals that never participated in GWTG-HF and 9.6% at hospitals that joined GWTG-HF before hospitalization. Unadjusted median GDMT scores increased from 3.0 in both groups to 4.0 in non-participating hospitals and 4.5 in GWTG-HF hospitals at 90 days (p<0.001). Hospital enrollment was associated with a higher 90-day GDMT score (+0.15 points; 95% CI 0.12-0.18; p<0.001), and greater use of beta blockers, RASI, and MRA, but not ARNI. HF readmission did not differ significantly; however, GWTG-HF participation was associated with lower all-cause mortality at 30 days (OR 0.95; 95% CI:0.92-0.98), 90 days (OR: 0.97; 95% CI: 0.95-0.99), and 1 year (0.97; 95% CI: 0.95-.0.99; all p<0.05). Conclusion Hospital participation in GWTG-HF was associated with higher GDMT intensity and lower mortality, supporting structured quality programs to improve HFrEF care.
Verma et al. (2026) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=1,274,863). Hospital participation in Get With The Guidelines-Heart Failure (GWTG-HF) program vs. Hospitals that never participated in GWTG-HF was evaluated on 90-day post-discharge prescription-fill GDMT score (+0.15 points, 95% CI 0.12-0.18, p=<0.001). Hospital participation in the GWTG-HF program was associated with a significantly higher 90-day post-discharge guideline-directed medical therapy score (+0.15 points) compared to non-participating hospitals.