Gaps in Guideline-Directed Medical Therapy for Heart Failure: A Cross-Sectional Study in an Underserved Population

Background: Heart failure (HF) remains a major clinical and public health challenge. Guideline-directed medical therapy (GDMT) has been shown to improve outcomes in patients with HF; however, gaps in the prescription and implementation of these therapies persist. These treatment gaps may contribute to suboptimal disease management and adverse clinical outcomes, highlighting the need to better understand patterns of GDMT utilization in diverse patient populations. In this study, we assessed and evaluated the prescribing patterns of GDMTs to an underserved population at an urban federally qualified health center (FQHC). Methods: We conducted a retrospective chart review of patients diagnosed with HF from May 2022 to June 2024 to assess the prescription of GDMT. Patients were classified based on echocardiographic findings as HF with reduced ejection fraction (HFrEF) (< 50%) and HF with preserved ejection fraction (HFpEF) (≥ 50%). Baseline demographics and prescription of GDMTs were compared between the two HF diagnoses. Results: Fifty patients with HF were identified in the study period, including 41 with HFrEF and nine with HFpEF. There was a significant difference in the mean age between patients diagnosed with HFpEF (68 years) as compared to patients with HFrEF (58 years) (p=0.02). Among patients with HFrEF, 93% (n=38) were prescribed beta-blockers (BB), 83% (n=34) were prescribed angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNi), 29% (n=12) were prescribed mineralocorticoid receptor antagonists (MRA), and 34% (n=14) were prescribed sodium-glucose cotransporter-2 inhibitors (SGLT2). Prescriptions for these medical therapies were similar among patients with HFpEF, except that 0% were prescribed an SGLT2 medication (p=0.05 for comparison with patients with HFrEF). Conclusions: GDMT is under-prescribed in underserved populations, underscoring the need for specific interventions to address financial, systemic, and educational barriers. Interventions such as patient education initiatives, financial counseling support, provider training programs, and policy changes to improve medication affordability and access should be prioritized to help close these treatment gaps.