A Quality Improvement Initiative on Documentation of Guideline-Directed Medical Therapy Implementation Among Primary Prevention CRT-D Implant

The treatment for heart failure with reduced ejection fraction has advanced significantly in recent years. The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America Guideline for the Management of Heart Failure recommends 4 pillars of medication in its guideline-directed medical therapy (GDMT): sodium-glucose cotransporter-2 inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and angiotensin-converting enzyme inhibitors or angiotensin receptor-neprilysin inhibitors. The implementation of GDMT at maximally tolerated doses has been proven effective in multiple trials. Rates of quadruple GDMT adoption among patients with cardiac resynchronization therapy with defibrillator (CRT-D) remain suboptimal in the published literature. We explored challenges to documentation on GDMT use among patients with CRT-D and identified different approaches to overcome them. This article highlights our observations and findings.