<div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="1866182350" paraeid="{f9df1493-9806-4ac2-b26f-bf6c66d897c1}{113}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Not even one-quarter of veterans with heart failure with reduced ejection fraction (</span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">HFrEF</span><span class="NormalTextRun SCXW188993615 BCX0">) receive<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">timely</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>quadruple guideline-directed medical therapy (GDMT) after diagnosis of heart failure, a new<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">study<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">shows.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="424475337" paraeid="{f9df1493-9806-4ac2-b26f-bf6c66d897c1}{178}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Joshua A. Jacobs, PharmD, PhD, of the Spencer Fox Eccles University of Utah School of Medicine, Salt Lake City, and colleagues, reported<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW188993615 BCX0">these</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>data in a manuscript published online Wednesday in<span> </span></span></span><span class="NormalTextRun SCXW188993615 BCX0">JAMA Cardiology</span><span class="NormalTextRun SCXW188993615 BCX0">.</span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="1657579534" paraeid="{89378ced-e5ea-491c-bccc-6830053211e4}{163}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">“These findings underscore the need for novel strategies to optimize care, with a focus on both early initiation and faster implementation of guideline-directed medical therapies,” Dr. Jacobs told<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">CRTonline</span><span class="NormalTextRun SCXW188993615 BCX0">.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="599331684" paraeid="{e359261a-0ccd-4554-8d58-885c67958577}{87}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Patients with HFrEF have improved outcomes when they quickly receive quadruple GDMT, but the general time it<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">takes</span><span> </span><span class="NormalTextRun SCXW188993615 BCX0">patients to receive quadruple therapy is unknown.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="585785606" paraeid="{34946f81-151c-428e-bae2-df4ab43718e2}{229}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Investigators in this retrospective, cohort study included patients from the Veterans Health Administration database who had incident<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">HFrEF</span><span class="NormalTextRun SCXW188993615 BCX0">. Data were collected from January 1, 2020, through December 31, 2023, and analyzed from November 2024 through December 2025.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="49737198" paraeid="{1102c18d-291e-44e1-8922-8a5dc8ad34e2}{123}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Quadruple therapy according to pharmacy data on whether prescriptions were filled was the primary endpoint in this trial, including concurrent use of evidence-based beta-blockers, renin-angiotensin system inhibitors, mineralocorticoid receptor<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">antagonists</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>and sodium-glucose cotransporter-2 inhibitors.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="1730193479" paraeid="{43981242-8790-413b-bd0d-b4c20181f2a8}{49}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">The definition of t</span><span class="NormalTextRun SCXW188993615 BCX0">ime to quadruple therapy (TTQ)<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">was the first date where all four medications overlapped based on the dates the medications were dispensed and the days’ supply. The investigators examined the TTQ and outcomes in<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">HFrEF</span><span> </span><span class="NormalTextRun SCXW188993615 BCX0">patients.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="2111216156" paraeid="{8046e385-b081-4da2-94c4-7c00aa7e7d9e}{221}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">A total of 52,850 patients had incident HFrEF (median age=71.8 years; 20% Black, 5% Hispanic, 68% White</span><span class="NormalTextRun SCXW188993615 BCX0">; 2.6% women</span><span class="NormalTextRun SCXW188993615 BCX0">), and 21.2% of these patients had quadruple medical therapy<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">over the median follow-up time of 2.9 years.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="394548414" paraeid="{95374a08-7944-44bb-829e-dbf382d26bfc}{216}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Black, Hispanic and patients who reported being from other racial groups had higher rates of quadruple medical therapy compared with White patients. No differences were<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">observed</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>between men and women across all groups.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="1518153870" paraeid="{c8bb6067-6a1e-48b9-911f-2818b3480f68}{174}"><span class="NormalTextRun SCXW188993615 BCX0">When prescriptions had copays, patients were 8% less likely to achieve quadruple therapy versus prescriptions without copays.</span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="2132647904" paraeid="{fa5ce20c-9ad2-4f4c-a87a-6c737dee9d92}{10}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Veterans with outpatient<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">HFrEF</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>had higher rates of achieving quadruple therapy (22.2%) versus inpatient veterans (14.2%). Additionally, patients with diabetes had higher rates of<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">quadruple therapy versus patients without (23.6% vs 19.3%), and patients without chronic kidney disease were more likely to have quadruple therapy (22.5%) versus patients with chronic kidney disease (18.1%).</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="1764962866" paraeid="{4ff5d759-270c-4303-985e-4114b29564f8}{246}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">“Among VA patients with a new diagnosis of heart failure between 2020 and 2023, fewer than 1 in 4 achieved optimal medication therapy, with a median time of 6 months to reach it,” Dr. Jacobs told<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">CRTonline</span><span class="NormalTextRun SCXW188993615 BCX0">.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="1164883850" paraeid="{f247661d-17af-41c7-bd0a-b4f29f3c543f}{218}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Overall, results from this cohort study<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">indicate</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>that fewer than 25% of veterans with<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">HFrEF</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>receive the proper quadruple medical therapy treatment for reducing mortality and morbidity in<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">HFrEF</span><span class="NormalTextRun SCXW188993615 BCX0">.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="1723597683" paraeid="{f466b1ef-3e17-4a27-8ffc-4e5d919d5656}{172}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Barriers to</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>access, such as medication copays, could change these numbers. Addressing other disparities that limit access to care could also be a point of further research.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="1120141797" paraeid="{ff070517-9f5a-449f-a50d-83a4d393b541}{10}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">In an accompanying editorial comment, Neil M. Kalwani, MD, MPP, of the VA Palo Alto Health Care System and Stanford University<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">School of Medicine, California</span><span class="NormalTextRun SCXW188993615 BCX0">; Je</span><span class="NormalTextRun SCXW188993615 BCX0">ssica R.<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">Golbus</span><span class="NormalTextRun SCXW188993615 BCX0">, MD, MS</span><span class="NormalTextRun SCXW188993615 BCX0">, of the University of Michigan, Ann Arbor</span><span class="NormalTextRun SCXW188993615 BCX0">; and Stephen J. Greene, MD,<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">of the Duke University School of Medicine, Durham, North Carolina, discussed the impacts of heart failure on the U.S. population and the associated treatments for<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">HFrEF</span><span class="NormalTextRun SCXW188993615 BCX0">.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="380193618" paraeid="{427b3150-570d-43e5-88e2-9d24b3d6b792}{50}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">“The findings of this study make clear that<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW188993615 BCX0">a greater</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>emphasis is needed on the speed of GDMT initiation after HF diagnosis,” the editorialists wrote.</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="1859193863" paraeid="{427b3150-570d-43e5-88e2-9d24b3d6b792}{208}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">“The prevailing practice of incremental,<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">slow</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>and steady GDMT treatment<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">is misaligned</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>with the high clinical risk these patients face. To approach<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">HFrEF</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>with the urgency it deserves, we must recognize the need for speed in treatment.”</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="824454324" paraeid="{8152c041-d1eb-4e8f-95b1-31c75052d4b1}{217}"><strong><span class="NormalTextRun SCXW188993615 BCX0">Sources:</span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="620578546" paraeid="{ff070517-9f5a-449f-a50d-83a4d393b541}{2}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Jacobs JA, Greene T, Vanneman ME, et al. Time to quadruple therapy after<span> </span></span><span class="NormalTextRun SCXW188993615 BCX0">initial</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>diagnosis of heart failure with reduced ejection fraction.<span> </span></span></span><em><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">JAMA </span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">Cardiol</span></span></em><span class="NormalTextRun SCXW188993615 BCX0">. 2026 April 1 (Article in Press).</span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="910863985" paraeid="{33e82aa5-3fa5-4733-bab8-a68bbf9f38c1}{232}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Kalwani NM,<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">Golbus</span><span class="NormalTextRun SCXW188993615 BCX0"><span> </span>JR, Greene SJ. Prioritizing time from diagnosis to quadruple therapy in heart failure care.<span> </span></span></span><em><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">JAMA </span><span class="NormalTextRun SpellingErrorV2Themed SCXW188993615 BCX0">Cardiol</span></span></em><span class="NormalTextRun SCXW188993615 BCX0">. 2026 April 1 (Article in Press).<span> </span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW188993615 BCX0"> <p class="Paragraph SCXW188993615 BCX0" xml:lang="EN-US" lang="EN-US" paraid="497227783" paraeid="{ab9db050-9c5d-4b40-a119-5034a9b5c174}{45}"><strong><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun MacChromeBold SCXW188993615 BCX0"><span class="NormalTextRun SCXW188993615 BCX0">Image </span><span class="NormalTextRun SCXW188993615 BCX0">Credit: </span><span class="NormalTextRun SCXW188993615 BCX0">OnPoint/peopleimages.com </span><span class="NormalTextRun SCXW188993615 BCX0">– stock.adobe.com</span></span><span class="EOP Selected SCXW188993615 BCX0" data-ccp-props="{}"> </span></strong></p> </div>