Heart failure & cardiomyopathies
Time to Quadruple Therapy After Initial Diagnosis of Heart Failure With Reduced Ejection Fraction
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.
Summarised from the published abstract; every number is checked against it