Quadruple medical therapy sets the standard for heart failure with reduced ejection fraction. Many US patients still face poor outcomes despite guidelines. This study checks real-world results and costs after hospital discharge. The results were published in the JAMA Cardiology.
Objective Tracks Outcomes Post-Discharge
Researchers wanted to measure mortality, HF readmissions, and healthcare spending in HFrEF patients sent home on quadruple therapy. They focused on Medicare data from busy US hospitals to spot residual risks.
Design Draws from National Registry
This retrospective cohort used Get With The Guidelines-Heart Failure registry data. It included Medicare patients hospitalized for HFrEF from July 2021 to December 2023 across 532 hospitals. Analysis ran October 2024 to March 2025 on those discharged with any dose of ARNI, beta-blocker, MRA, and SGLT2 inhibitor.
Results Highlight High Residual Burden
Of 20,651 eligible patients, only 1490 (7.2%) got quadruple therapy, with big hospital differences (MOR 2.04, 95% CI 1.89-2.24). Median age was 74 years; 36.4% women. Over 12 months, all-cause mortality reached 19.3% (95% CI 17.3-21.4%). HF hospitalization was 26.0% (23.6-28.5%). Combined mortality or HF event hit 37.1% (34.4-39.8%). Median per-patient cost stood at $27,956 (IQR $7,478-$61,126).
Conclusions Urge Beyond Quadruple Solutions
Even on full therapy, older HFrEF patients suffer high death and readmission rates plus steep costs. Hospitals vary widely in prescribing. New strategies must tackle this leftover risk.