Heart Failure Clinic: Patients With HFrEF Not Receiving GDMT at Target Doses

Talking to patient about medication
Using a retrospective analysis, researchers analyzed whether patients with heart failure at a clinic were receiving recommended doses for guideline-directed medical therapy.

Researchers from Emory University found they were not prescribing sufficient doses of guideline-directed medical therapy (GDMT) at their safety-net heart failure (HF) clinic. The study findings were presented during the American Heart Association (AHA) Scientific Sessions, held virtually from November 13 to 15, 2021.

A key to ensuring improved HF outcomes, and ultimately reducing health care costs, is to practice initiation, optimization, and maintenance of GDMT dosing for patients with HF with reduced ejection fraction (HFrEF). The American College of Cardiology (ACC)/AHA/Heart Failure Society of America (HFSA) guidelines recommend for the maximum tolerated doses to be given to this patient population unless contraindications are present. In general, GDMT doses are underutilized.

In order to assess how well their HF clinic was following guidelines, the study investigators retrospectively reviewed patient data (N=227) collected between January and March 2019. Researchers also assessed the proportion of patients on optimal doses (as defined by >50% of target dose or maximum tolerated dose) of beta blockers, renin-angiotensin-aldosterone system (RAAS) inhibitors, angiotensin receptor-neprilysin inhibitors (ARNIs), and mineralocorticoid antagonists (MRAs).

The patient population comprised 70% men with a mean age of 59±11 years, 94% of whom were Black. Most patients were using beta blockers (96%) and RASS inhibitors (88%); 30% used MRAs and 11% ARNIs.

The proportion of patients meeting the GDMT dosage was 52% of beta blocker users, 43% of ACEI/ARB users, and 20% of MRA users.

Altogether, these data indicated that contrary to the researchers’ hypothesis, the majority of patients with HFrEF at their HF clinic were not prescribed GDMT at recommended target doses. On the basis of these findings, the study authors stated they will be implementing a quality improvement process of early initiation and up-titration, so that GDMT dosage may be maintained at their clinic and help decrease morbidity and mortality in the patient population.

This study was limited, as it was a performed at a single center and results may not be generalizable to other centers.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Azobou Tonleu FH, Campbell ML, Miller SC, et al. Bridging the gap to optimal dosing for guideline-directed medical therapy for patients with heart failure and reduced ejection fraction. Presented at AHA Scientific Sessions 2021. Abstract 14276.