Heart failure patients on quadruple medical therapy still face considerable risks
When patients hospitalized for heart failure with reduced ejection fraction (HFrEF) are prescribed quadruple medical therapy at discharge, they still face high risks of dying or returning to the hospital within the next 12 months. That is according to a brand new analysis published in JAMA Cardiology.[1]
“For patients with HFrEF, combination quadruple medical therapy with angiotensin receptor–neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA), and sodium-glucose cotransporter 2 inhibitor (SGLT2i) is strongly recommended for reducing the risk of death and hospitalization,” wrote first author Stephen J. Greene, MD, a cardiologist with Duke University School of Medicine, and colleagues. “However, the residual risks of morbidity and mortality for patients with HFrEF in contemporary practice despite quadruple medical therapy have not been well characterized.”
Greene et al. reviewed data from the American Heart Association’s Get with the Guidelines-Heart Failure registry, focusing on more than 20,000 patients 65 years old or older who were hospitalized for HFrEF. Just 7.2% of patients were prescribed quadruple medical therapy at discharge as recommended.
Overall, after 12 months, all-cause mortality and heart failure hospitalizations occurred in 19.3% and 26% of patients, respectively. The median healthcare costs per patient after 12 months was $27,956.
“Despite class I guideline recommendations, only 1,490 of 20,651 patients with HFrEF eligible for quadruple medical therapy were prescribed simultaneous ARNI, beta-blocker, MRA and SGLT2i at hospital discharge,” the authors wrote. “Nonetheless, even when quadruple medical therapy was prescribed, HFrEF remained an extreme risk condition.”
The group added that improving the use of quadruple medical therapy should remain a priority going forward—as should identifying additional therapies that can improve outcomes for these high-risk patients.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.