Contemporary Guideline-Directed Medical Therapy for Heart Failure in the United States: The EMPACE Study - PubMed

2 days ago

The EMPACE study examined the use of guideline-directed medical therapy (GDMT) in US clinical practice among patients hospitalized with heart failure (HHF).
Among 17,210 patients, 73% had HF with reduced ejection fraction (HFrEF), 4% had HF with mildly reduced EF (HFmrEF), and 23% had HF with preserved EF (HFpEF).
Before HHF, only 1% of HFrEF patients received quadruple therapy, with low usage of individual therapies like beta blockers (68%), ACE inhibitors/ARBs (64%), MRAs (23%), ARNI (14%), and SGLT2i (5%).
Post-HHF, GDMT use improved modestly: quadruple therapy increased to 2%, beta blockers to 84%, ACE inhibitors/ARBs to 72%, MRAs to 38%, ARNI to 26%, and SGLT2i to 13%.
Time-to-initiation was longest for SGLT2i (88 days) and shortest for beta blockers (15 days), with mean time-to-quadruple therapy at 109 days.
ARNI had the highest 12-month discontinuation rate (62%), followed by MRAs (57%), SGLT2i (55%), and beta blockers (51%).
Among HFmrEF and HFpEF patients, SGLT2i usage was low pre-HHF (7% each) and slightly improved post-HHF (12% and 9%, respectively).
The study highlights significant gaps in prehospitalization GDMT and modest post-discharge improvements, with delayed initiation and high discontinuation rates.

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