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.
Clinical Best Practices
Related Resources & Content
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