Underutilization of Guideline-Directed Medical Therapy in Heart Failure With Reduced Ejection Fraction: A Retrospective Study in Rural Appalachia

A new study published in the journal Cureus has found that the implementation of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains suboptimal, despite its proven mortality benefits. The research, conducted at East Tennessee State University, analyzed data from three outpatient clinics and found that MRA use remains limited in patients with favorable profiles and high cost-benefit ratios.

Key Takeaways:

• The study found that SGLT2i therapy was more common in younger patients with lower ejection fraction and lower SBP.
• Type 2 diabetes mellitus was the strongest predictor for both SGLT2i initiation and dose optimization.
• The study highlighted a significant gap in GDMT implementation, with only 50% of the target dose being used in many patients.
• Targeted interventions to support GDMT initiation and optimization in eligible patients may help reduce disparities in heart failure care.
• The research excluded patients with contraindications to GDMT, end-stage renal disease, or limited life expectancy.

Statistics:

• 50% of patients received fewer than the target dose of GDMT.
• SGLT2i therapy was more common in patients with lower ejection fraction (EF < 40%) and lower systolic blood pressure (SBP) < 140 mmHg.
• Type 2 diabetes mellitus was the strongest predictor for both SGLT2i initiation (93.2%) and dose optimization (95.5%).
• A total of 1,234 patients were included in the study, with 1,017 (82.2%) being eligible for GDMT.
• The study was conducted in three outpatient clinics within the East Tennessee State University Health system.