Older patients with heart failure with reduced ejection fraction (HFrEF) are at significantly higher risk of death and hospital readmission for heart failure even after being prescribed quadruple medical therapy for treatment, a cohort study shows. Health care costs are often higher in treating this patient population as well. Stephen J. Greene, MD, from the Duke Clinical Research Institute, Durham, North Carolina, and colleagues, reported the corresponding data in a manuscript published Wednesday online in JAMA Cardiology. Several medications are giving to patients with HFrEF to prevent death and hospitalization. However, the clinical effects of these medications over time are not well defined. Dr. Greene and colleagues examined patients who were Medicare beneficiaries and hospitalized for HFrEF between July 1, 2021, and December 31, 2023. The Get With The Guidelines-Heart Failure registry was used for collecting data. Patients were discharged from U.S. hospitals and received quadruple medical therapy: an angiotension receptor-neprilysin inhibitor, β-blocker, mineralocorticoid receptor antagonist and sodium-glucose cotransporter 2 inhibitor. Death, hospitalization for HF, death or HF hospitalization and expenses per-patient were the primary outcomes in this trial. A total of 1,490 patients (median age=74 years, 36.4% women), of the 20,651 eligible, were prescribed quadruple medical therapy upon discharge from the hospital. At 12-months follow-up, 19.3% of patients died, 26.0% of patients were hospitalized due to HF and 37.1% of patients experienced either all-cause mortality or HF hospitalization. The results were similar in both halves of the study period. Also measured at 12 months, the median health care expense for each patient was $27,956 (ranged from $7,478 to $61,126). A key limitation of this study is the older population, which carries a higher absolute risk of mortality and hospitalization. Additionally, the investigators in this study were unable to assess patients’ medication adherence after patients were discharged from the hospital. Overall, older patients prescribed quadruple medical therapy for HFrEF continue to have a high risk for death or HF hospitalization despite the extensive treatments. Nearly one fifth of patients died within a year of receiving therapy. This population also has a high cost of care. Source: Greene SJ, Xu H, Chiswell K, et al. One-year outcomes in patients hospitalized for heart failure with reduced ejection fraction prescribed quadruple medical therapy at discharge. JAMA Cardiol. 2026 January (Article in Press). Image Credit: Burlingham – stock.adobe.com