Clinical Scorecard: How Quickly Are Patients Reaching Quadruple HFrEF Therapy?
At a Glance
Category
Detail
Condition
Key Mechanisms
Quadruple guideline-directed medical therapy includes an evidence-based beta-blocker, renin-angiotensin system inhibitor, mineralocorticoid receptor antagonist, and sodium-glucose cotransporter-2 (SGLT2) inhibitor.
Target Population
Care Setting
Key Highlights
Less than 25% of patients achieved quadruple therapy during a median follow-up of 2.9 years.
Median time to quadruple therapy was over 6 months.
Overall mortality rate was about 31%, with 91% of deaths occurring before achieving quadruple therapy.
Adjusted rates of quadruple therapy were higher among Black and Hispanic patients compared to White patients.
Inpatient diagnosis was associated with a 50% lower likelihood of achieving quadruple therapy within 6 months.
Guideline-Based Recommendations
Diagnosis
Incident HFrEF defined using ICD-10 heart failure diagnosis code and left ventricular ejection fraction of 40% or less.
Management
Initiate quadruple therapy as per guideline-directed medical therapy.
Monitoring & Follow-up
Monitor prescription fills for evidence-based medications.
Risks
Patients face high clinical risk; slow initiation of therapy is misaligned with this risk.
Patient & Prescribing Data
52,850 adult patients with incident HFrEF in the VHA.
78% had at least one prescription fill for beta-blockers; 79% for renin-angiotensin inhibitors; 38% for mineralocorticoid receptor antagonists; 46% for SGLT2 inhibitors.
