Guideline-Directed Medical Therapies Among Patients With Heart Failure Enrolled in Cardiac Rehabilitation.

PURPOSE: Cardiac rehabilitation (CR) could be an important opportunity for optimization of guideline-directed medical therapies (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF). We set out to describe GDMT prescribing among enrollees in CR with HFrEF.

METHODS

We queried the electronic health record of an academic medical center and identified patients with HFrEF who attended CR between 2016 and 2023. We defined CR cycles as at least 6 CR sessions with fewer than 6 months between sessions. Using a validated algorithm, we generated medication optimization scores (MOS, 0%-100% optimized) at the first and final CR session. The algorithm's input included GDMT, New York Heart Association classification, systolic blood pressure, heart rate, creatinine, potassium, allergies, and race. Wilcoxon Signed-Rank analysis was used to compare MOS.

RESULTS

A total of 172 CR cycles were completed by 152 patients (64% male, 78% White, 67.5 ± 12.1 years old). Mean sessions per CR cycle was 26.4 ± 10.6. At the end of CR, 85 (49%) patients were on a beta-blocker, 84 (49%) a renin-angiotensin-aldosterone inhibitor, and 31 (18%) a mineralocorticoid receptor antagonist. Accounting for contraindications, patients were eligible for initiation or uptitration of at least 1 GDMT class after 84% of cycles. Median MOS at the start of CR was 39% (IQR: 14, 57) and 35% (IQR: 14, 57) at the end of CR ( P = .90).

CONCLUSION

GDMT utilization among patients with HFrEF in CR is suboptimal. There is a substantial opportunity to develop and validate strategies to improve GDMT prescribing during CR.