Impact of Guideline-Directed Medication Titration Velocity in Patients With Heart Failure With Reduced Ejection Fraction

This study evaluated whether shorter time to achieving targeted guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) was associated with greater improvement in left ventricular ejection fraction (LVEF). GDMT reduces morbidity and mortality in HFrEF. It is unclear whether the speed of achieving target doses influences improvement in LVEF or related outcomes. This retrospective study included new HFrEF patients seen in a heart failure clinic between January 1 st , 2021 and January 1 st , 2023 that met study criteria. The primary outcome was improvement in LVEF. Secondary outcomes included reduction in mitral valve regurgitation (MVR) severity and differences in LVEF improvement by provider type. Titration velocity was defined as time from first heart failure visit to attainment of target or maximally tolerated GDMT doses. Eighty-seven patients were included in the study (mean age 61 years; 64.4% male; 58.6% white). After GDMT titration, 90.8% demonstrated improvement in LVEF. Mean time to full GDMT titration was 146.6 days (<6 months). Mean LVEF improvement was 19.5% (<3 months), 19.1% (3-6 months), 21.0% (6-9 months), and 17.3% (>9 months), with no significant difference among groups ( P = 0.823). No significant differences were observed in MVR reduction ( P = 0.523) or LVEF improvement by provider type ( P = 0.703). GDMT titration velocity was not associated with significant differences in LVEF improvement. These findings support individualized GDMT optimization rather than emphasizing rapid dose escalation and suggest potential benefits of longer therapy duration allowing additional time for specialty evaluation and avoiding premature device implantation.