Barriers to Starting Four-Drug Therapy for HF with Reduced Ejection Fraction

Guideline-directed medical therapy (GDMT) for patients who have heart failure with reduced ejection fraction (HFrEF) includes an HF-appropriate beta-blocker, a mineralocorticoid receptor antagonist, a sodium–glucose cotransporter-2 inhibitor, and a renin–angiotensin system inhibitor. Timely initiation of this four-drug therapy improves patient outcomes. In a new study, researchers assessed the time to quadruple therapy in 53,000 U.S. military veterans (97% men) who were diagnosed with incident HFrEF from 2020 to 2023 (13% as inpatients) and who were deemed eligible for treatment without contraindications to any of the four drug classes.