https://jamanetwork.com/journals/jamacardiology/article-abstract/2846899Achieving all four guideline-directed medical therapies remains a key objective in the management of heart failure with reduced ejection fraction (HFrEF), yet the timing and uptake of this approach in routine practice are not well defined. A retrospective cohort study published in JAMA Cardiology examined patterns of time to quadruple therapy (TTQ) and factors associated with its attainment in a large Veterans Health Administration population.

The study included 52,850 patients with newly diagnosed HFrEF between 2020 and 2023, with a median age of 71.8 years and a predominantly male population (97%). Over a median follow-up of 2.9 years, 21.2% of patients received all four recommended medication classes concurrently.

The median time to quadruple therapy was 197 days, with wide variability (IQR, 49–528 days).
Rates of therapy attainment varied across clinical and demographic groups. After adjustment, Black, Hispanic, and other racial or ethnic groups had higher rates of quadruple therapy compared with White patients, while no difference was observed between sexes. Patients with prescription copays had lower rates of therapy attainment than those without copays (HR, 0.92; 95% CI, 0.87–0.96). Higher rates were also observed among patients diagnosed in outpatient settings, those with diabetes, and those without chronic kidney disease.

These findings indicate that both uptake and timing of quadruple GDMT remain suboptimal, with variation across patient and health system factors.