Key result
Private hospital care linked to ~32-point higher quadruple therapy prescribing for HFrEF vs public hospitals.
Why the study?
Although 2023 ESC guidelines reinforce quadruple therapy for HFrEF, real-world implementation remains varied across healthcare sectors, and potential differences between private and public hospitals required evaluation.
Does care in a tertiary private hospital compared to a tertiary public hospital improve adherence to ESC-recommended guideline-directed medical therapy at discharge in patients with HFrEF?
Cross-Sectional (n=100)
Yes
Does care in a tertiary private hospital compared to a tertiary public hospital improve adherence to ESC-recommended guideline-directed medical therapy at discharge in patients with HFrEF?
Significant sector-level disparities exist in HFrEF care, with private hospital patients more than twice as likely to receive optimal quadruple guideline-directed medical therapy at discharge compared to public hospital patients, largely driven by higher SGLT2 inhibitor and MRA prescribing.
Answers are grounded in this paper and cite their sources.
HFrEF quadruple therapy disparities between private and public hospitals warrant targeted quality initiatives; leaves open causal mechanisms and outcome effects.
Background In patients with heart failure with reduced ejection fraction (HFrEF), guideline-directed medical therapy (GDMT) is crucial for reducing morbidity and mortality. The 2023 European Society of Cardiology (ESC) ‘Focused Update’ on heart failure reinforces the ‘Four Pillars’ of HFrEF treatment as Class I recommendations. However, real-world implementation in clinical practice often remains varied across different healthcare sectors. Purpose To evaluate adherence to ESC-recommended GDMT in patients with HFrEF and to examine whether there are sector-level differences in implementation between private and public hospitals. Methods We conducted a retrospective cross-sectional study of 100 consecutive patients with HFrEF discharged between June 2025 and February 2026. Patients were equally divided between a tertiary public hospital and a tertiary private hospital (n=50 each). Prescription of ACEi/ARB/ARNI, beta-blockers, mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors at discharge was recorded. Quadruple therapy (QT) was defined as the prescription of all four drug classes. Relevant demographics and clinical variables, including age, type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and NYHA class, were documented. A GDMT score (0–4) was calculated. Group comparisons were performed using chi-square testing. Results Between the two cohorts, baseline characteristics were comparable in mean age (73.4 vs 71.6, p=0.38), NYHA class distribution (p=0.36), T2DM prevalence (42% vs 36%, p=0.68) and CKD (4% vs 2%, p=1.00). 54% of patients in the private hospital were prescribed QT, compared with only 22% in the public hospital (p<0.001). The use of SGLT2 inhibitors was significantly higher in the private sector (98% vs 42%, p<0.001), as was MRA prescription (96% vs 78%, p=0.007). We found no substantial differences in ACEi/ARB/ARNI (64% vs 70%, p=0.52) and beta-blockers (80% vs 84%, p=0.50) use. Among patients with diabetes, SGLT2 inhibitors were prescribed in 100% of cases in the private hospital compared with 61.1% in the public hospital (p=0.006). The mean GDMT score was higher in the private hospital (3.38 vs 2.74), reflecting greater overall implementation of guideline-directed therapy. Conclusion There are significant differences in how different healthcare sectors apply ESC-recommended GDMT for HFrEF. Despite comparable baseline characteristics, optimal QT was more frequently prescribed to patients with HFrEF in the private hospital. Additionally, SGLT2 inhibitors remain under-prescribed in the public hospital, highlighting an underlying gap and the need for standardised adoption of GDMT. This may reflect variation in access, affordability, or institutional prescribing systems, alongside potential therapeutic inertia. Further large-scale studies and targeted strategies are necessary to ensure equitable delivery of evidence-based heart failure care.
No takes yet. Share an insight, caveat, or question.
Niraula et al. (2026) conducted a cross-sectional in Heart failure with reduced ejection fraction (HFrEF) (n=100). Tertiary private hospital care vs. Tertiary public hospital care was evaluated on Prescription of quadruple therapy (ACEi/ARB/ARNI, beta-blockers, MRA, and SGLT2 inhibitors) at discharge (p=<0.001). Private hospital care was associated with higher prescription rates of guideline-directed quadruple therapy at discharge for HFrEF than public hospital care (54% vs 22%, p<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: