Almost 7 million people are living with heart failure in the United States. Guideline Directed Medical Therapy (GDMT) is often recommended for patients with heart failure with reduced ejection fraction (HFrEF) but use of GDMT for patients with HFrEF remains low. The new article “Guideline-Directed Medical Therapies Among Patients with Heart Failure Enrolled in Cardiac Rehabilitation” aimed to study the use of GDMT among patients enrolled in cardiac rehabilitation (CR) with HFrEF to determine current utilization and opportunities for GDMT optimization in this population.

The researchers reviewed medical records for patients with HFrEF that attended CR at a large academic medical center between January 2016 and August 2023. Patients were only included in the analysis if they attended at least 6 CR sessions with no gaps exceeding 6 months between sessions. The specific inclusion criteria for the study was to ensure that enough time to allow for medical titration (at minimum a 2-3 week period) for GDMT during the course of their participation in CR. Patients were assigned a medical optimization score (MOS) based on a validated algorithm that takes a variety of data points into account when assigning scores, including the patient’s use of any current GDMT medications, their  New York Heart Failure Association Classification, heart rate, blood pressure, allergies and race, among other inputs. The research team then reviewed the MOS scores for patients at their first and final CR sessions to determine the impact, if any, of participation in CR on MOS scores for GDMT.

The analysis determined that the median MOS at the start of CR was 39%, and at the end of CR was just 35%. Furthermore, 84% of patients were flagged as being suitable candidates for initiation or up titration of at least one type of GDMT at the end of their participation in CR.

In the study population, MOS scores also did not change significantly between the first and final sessions of CR; the MOS category increased for 35% of patients, did not change for 31% of patients, and decreased for 34% of patients between the first session and the last session. Subgroup analyses did not find any significant differences in MOS based on demographic characteristics, age, or comorbidities.

While the analysis did not see significant differences in GDMT at the first session compared to the final session, the research team does suggest that CR programs may be well-suited to help address optimization of GDMT for HFrEF patients due to the typical session schedule that could allow for thoughtful initiation and titration of medications in combination with patient counseling and education to help optimize GDMT and ensure patient adherence to GDMT. Future studies should be conducted to determine effective strategies for optimizing GDMT during participation in CR.

 A visual abstract representing the results of the study is included below, and the full article can be found in the September issue of JCRP. AACVPR members can access full journal content through the AACVPR Website portal here: https://www.aacvpr.org/jcrp.