Introduction: Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) includes a combination of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB)/angiotensin receptor neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor agonists (MRA), and sodium-glucose co-transporter 2 inhibitors (SGLT2i). Despite mortality benefits, implementation remains suboptimal. Methods: This was a retrospective observational study conducted in three outpatient Internal Medicine and Cardiology clinics within the East Tennessee State University Health system. Adults aged ≥18 years with ejection fraction (EF) ≤40% and at least one outpatient follow-up between December 2022 and November 2023 were included. Patients with contraindications to GDMT, end-stage renal disease, or limited life expectancy were excluded. GDMT use and dosing (none, 50% of the target dose. SGLT2i therapy was more common in younger patients with lower ejection fraction and lower SBP, with type 2 diabetes mellitus being the strongest predictor for both initiation and dose optimization. Conclusion: These findings highlight a significant gap in GDMT implementation. Despite favorable patient profiles and a high cost-benefit ratio, MRA use remains limited in this cohort. Targeted interventions to support GDMT initiation and optimization in eligible patients may help reduce disparities in heart failure care.
Sanku et al. (Tue,) studied this question.