Application of guideline-directed medical therapy in women with chronic heart failure

To analyze the implementation status of guideline-directed medical therapy (GDMT) in women with chronic heart failure (HF). This cross-sectional study included women with chronic HF admitted to Lanzhou University Second Hospital from January 2022 to December 2025. Patients were categorized into three groups according to left ventricular ejection fraction (LVEF): heart failure with reduced ejection fraction (HFrEF, LVEF ≤ 40%), heart failure with mildly reduced ejection fraction (HFmrEF, LVEF 41–49%), and heart failure with preserved ejection fraction (HFpEF, LVEF ≥ 50%). Age stratification was performed into age groups (< 65 years, 65–79 years, and ≥ 80 years). Demographic data, laboratory examinations, echocardiographic findings, and medication use were collected. A total of 731 patients were enrolled, including 209 (28.6%) in the HFrEF group, 101 (13.8%) in the HFmrEF group, and 421 (57.6%) in the HFpEF group. In the HFrEF group, 55.0% of patients received quadruple therapy, the utilization rates of beta-blocker, angiotensin-converting enzyme inhibitors(ACEI)/angiotensin II receptor blockers(ARB), angiotensin receptor-neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonist (MRA), and sodium-glucose cotransporter-2 inhibitor (SGLT2i) were 82.3%, 1.4%, 81.3%, 86.1%, and 86.1%, respectively; 100% target-dose achievement rates were 0%, 0%, 1.2%, 98.9%, and 100%. In HFmrEF patients, 38.6% received quadruple therapy; utilization rates of the above agents were 72.3%, 2.0%, 74.3%, 75.2%, and 77.2%, respectively, with 100% target-dose achievement rates of 2.7%, 0%, 4.0%, 97.4%, and 100%. In the HFpEF group, 46.6% of patients received SGLT2i therapy; among these treated patients, 99.0% achieved the guideline-recommended treatment dose. The utilization rate of SGLT2i was lower in patients aged ≥ 80 years (35.3%). Among patients with HFrEF discharged from this center, the proportion of quadruple prescriptions is 55%; the doses of ARNI and beta-blocker were predominantly within the low range. The utilization rate of SGLT2i among HFpEF patients was limited.