Heart failure & cardiomyopathiesCohort study
Time to Quadruple Therapy After Initial Diagnosis of Heart Failure With Reduced Ejection Fraction
- Retrospective cohort study
Authors' conclusion
Results of this cohort study suggest that opportunities exist to improve both the rate and timeliness of quadruple therapy as only 21.2% of patients with HFrEF achieved it, with a median follow-up of 2.9 years and TTQ of 6 months.
Study context
- Population
- Patients with incident heart failure with reduced ejection fraction (HFrEF), Veterans Health Administration database, 2020–2023
- Participants
- 52,850 patients
- Exposure
- Factors associated with time to quadruple GDMT
- Whiten = 35,867reference
- Blackn = 10,791
- Hispanicn = 2,528
- Othern = 3,664
- Outcome
- Quadruple therapy (concurrent β-blocker, RAS inhibitor, MRA, SGLT2 inhibitor by pharmacy fills); TTQ = first date all 4 classes overlapped
Main finding
As reported in the abstract
Quadruple therapy achievement and TTQ · median (IQR) follow-up 2.9 (1.9-3.9) years
Hazard ratio (95% CI)
Black vs Whiteadjusted; rate of quadruple therapy
1.22(1.15–1.30)
Hispanic vs Whiteadjusted
1.21(1.09–1.33)
Other vs Whiteadjusted
1.11(1.02–1.20)
Females vs Malesno difference in TTQ
0.97(0.86–1.09)
Prescription copays (priority groups 2-8) vs No prescription copay (priority group 1)8% lower rate
0.92(0.87–0.96)
- Achieved quadruple therapy
- 11 217 (21.2%)
- Median (IQR) TTQ
- 197 (49-528) days
Observational data: associations, not effects.
Further findings
Rate of quadruple therapy by clinical characteristics
- Outpatient vs inpatient HFrEF diagnosis
- 22.2% vs 14.2%
- With vs without DM
- 23.6% vs 19.3%
- Without vs with CKD
- 22.5% vs 18.1%
Original publication
Time to Quadruple Therapy After Initial Diagnosis of Heart Failure With Reduced Ejection Fraction. JAMA Cardiol. Published 1 June 2026. doi:10.1001/jamacardio.2026.0375
Summarised from the published abstract; every number is checked against it