Utilization of guideline‑directed medical therapy for heart failure with reduced ejection fraction: a retrospective chart review in a teaching hospital

Abstract

Background and Purpose: Guideline‑directed medical therapy improves outcomes in heart failure with reduced ejection fraction, yet uptake is often suboptimal. We evaluated real‑world use of guideline‑directed therapy among adults hospitalized for decompensated heart failure in a tertiary teaching hospital and explored patient factors associated with under‑prescribing.

Methods: This retrospective review included consecutive adults with stable HFrEF (left ventricular ejection fraction ≤40 %) admitted to the cardiology service between January 2024 and April 2025. Under supervision, medical students extracted demographic data, comorbidities and discharge prescriptions from electronic records. Guideline therapy comprised any renin–angiotensin system inhibitor, beta‑blocker, mineralocorticoid receptor antagonist and sodium–glucose co‑transporter 2 inhibitor. We calculated prescription rates for each drug class and the proportion receiving all four therapies. Logistic regression examined associations between under‑prescribing and age, sex, low blood pressure, renal impairment and comorbidities.

Results: We reviewed 198 admissions (mean age 60 years; 30 % female). Prescription rates were 83 % for renin–angiotensin system inhibitors, 92 % for beta‑blockers, 56 % for mineralocorticoid receptor antagonists and 48 % for sodium–glucose co‑transporter 2 inhibitors. Only 38 % of patients received all four therapies. In multivariate analysis, moderate renal impairment (estimated glomerular filtration rate <45 mL min⁻¹ 1.73 m⁻²) predicted omission of renin–angiotensin system inhibitors (adjusted odds ratio 3.1). Systolic blood pressure <100 mmHg predicted non‑prescription of beta‑blockers (adjusted odds ratio 2.4). Age, sex and other comorbidities were not associated with under‑prescribing. Reasons for withholding drugs were rarely documented.

Conclusions: Less than half of HFrEF patients at this teaching hospital received the full combination of evidence‑based therapies. Concerns about renal function and hypotension contributed to under‑prescribing. Structured heart failure management pathways, improved documentation and educational initiatives may enhance adherence to guideline‑directed therapy in similar settings in practice.