Paul A. Heidenreich

The U.S. Department of Veterans Affairs and U.S. Department of Defense released an updated clinical practice guideline in December 2025 on lipid management for cardiovascular disease risk reduction... Description: In December 2025, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) released a clinical practice guideline (CPG) update on lipid management for card...

BACKGROUND: Despite strong evidence, adoption of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction remains suboptimal. The Get With The Guidelines–Heart Failure (GWTG-HF) program was designed to close gaps in care. We evaluated whether hospital participation in GWTG-HF was associated with greater GDMT intensity and improved outcomes. METHODS: We conducted a retrospective analysis (2013–2021) of Medicare beneficiaries with part A and part D hospitalized with heart failure with reduced ejection fraction. Using a multiple baseline time series design, we compared changes in GDMT and outcomes before and after GWTG-HF enrollment with hospitals that never participated. Coprimary outcomes were a 90-day postdischarge GDMT score under a parallel and nonparallel slopes model. Secondary outcomes included class-specific medication fills, achievement of ≥50% target doses, and 30-day, 90-day, and 1-year all-cause and HF readmission and mortality. Mortality and first HF readmission were also evaluated using Cox proportional hazards models. We adjusted for baseline hospital performance, patient characteristics, and temporal trends. RESULTS: Among 1274 863 Medicare beneficiaries hospitalized for heart failure with reduced ejection fraction, 53.5% were treated at hospitals that never participated in GWTG-HF and 9.6% at GWTG-HF hospitals. Unadjusted median GDMT scores increased from 3.0 in both groups to 4.0 in nonparticipating hospitals and 4.5 in GWTG-HF hospitals at 90 days ( P P P <0.05). Mortality differences were attenuated and no longer significant in the nonparallel slopes model. CONCLUSIONS: Hospital participation in GWTG-HF was associated with modest but significant improvements in postdischarge GDMT intensity, supporting the value of quality improvement initiatives to address persistent treatment gaps in heart failure with reduced ejection fraction.

BACKGROUND: The Get With The Guidelines-Heart Failure program is a national quality improvement initiative that was established in 2005 with the goal of improving the quality of care for patients hospitalized with heart failure. METHODS: We examined patient characteristics, adherence to achievement and quality measures, and in-hospital outcomes in patients hospitalized with heart failure among Get With The Guidelines-Heart Failure fully participating hospitals between 2005 and 2024. Measures were applied to eligible patients without documented contraindications. Multivariable regression analysis, adjusting for patient and hospital characteristics, was performed to assess temporal changes in individual measures and outcomes. RESULTS: Over the first 20 years, the Get With The Guidelines-Heart Failure program has grown to include 1 561 093 patient records (median age 73 [62–83], 47.4% women, median ejection fraction 45% [28%–58%]) and 819 participating hospitals. There was significant and sustained improvement in an all-or-none composite achievement metric, with an increase from 76.1% to 88.7% between 2005 and 2024 (adjusted odds ratio, 3.7 [95% CI, 3.5–4.0]; P P <0.001). Meanwhile, prescriptions of new therapies such as angiotensin receptor-neprilysin inhibitors and sodium-glucose cotransporter-2 inhibitors reached rates of 67.3% and 78.2% in 2024, respectively. Sustained improvements were also seen for other achievement and quality measures, including postdischarge follow-up and prescription of anticoagulation for patients with atrial fibrillation or atrial flutter. Equity of care by social vulnerability index also improved over time for guideline-based therapies such as evidence-based β-blockers and mineralocorticoid receptor antagonists. In contrast, vaccination rates and use of implantable cardioverter defibrillators saw recent decreases. CONCLUSIONS: The Get With The Guidelines-Heart Failure program was associated with sustained improvements in key achievement and quality measures for patients hospitalized with heart failure during its initial 2 decades, with a notable rise in the prescription of guideline-directed medical therapies and rapid implementation of new medications.

Background: Lipoprotein(a) (Lp[a]) can refine atherosclerotic cardiovascular disease risk assessment and guide lipid‐lowering therapy intensification (LLTI). However, the association between Lp(a) testing and LLTI across large health systems is not well characterized. Methods: Using Veterans Affairs electronic health record data, we conducted a retrospective cohort study of veterans undergoing lipid testing from January 1, 2017, to June 30, 2024. We first compared a 1:1 propensity‐matched cohort with concurrent low‐density lipoprotein cholesterol (LDL‐C) and Lp(a) testing with those with LDL‐C testing alone. We then compared veterans with elevated versus nonelevated Lp(a) (>50 versus 50 mg/dL) was present in 25% (n=2562). Lp(a) testing was associated with greater LLTI (odds ratio [OR], 2.11 [95% CI, 1.95–2.29]), LDL‐C testing (OR, 1.27 [95% CI, 1.19–1.36]), and LDL‐C goal attainment (OR, 1.22 [95% CI, 1.12–1.33]). Compared with Lp(a) 50 mg/dL was associated with increased LLTI (OR, 1.73 [95% CI, 1.55–1.94]). Lp(a) >100 mg/dL was associated with lower LDL‐C goal attainment (OR, 0.68 [95% CI, 0.56–0.84]). Conclusions: Lp(a) testing was associated with increased LLTI and LDL‐C goal attainment. Elevated Lp(a) identified individuals more likely to undergo LLTI, suggesting testing may motivate preventive treatment optimization.

Purpose: Despite strong evidence, real-world adoption of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains suboptimal. The Get With The Guidelines–Heart Failure (GWTG-HF) program was designed to close gaps in care. We evaluated whether hospital participation in GWTG-HF is associated with greater GDMT intensity and improved outcomes. Methods: We conducted a retrospective analysis (2013-2021) of Medicare beneficiaries with Part A and Part D hospitalized with HFrEF. Using a multiple baseline time series design, we compared changes in GDMT prescribing and outcomes at hospitals before and after GWTG-HF enrollment with hospitals that never participated. The primary outcome was a 90-day post-discharge prescription-fill GDMT score summarizing use and dose of beta blockers, renin-angiotensin system inhibitors (RASI; ACE inhibitor/ARB/ARNI), and mineralocorticoid receptor antagonists (MRA). Secondary outcomes included class-specific medication fills, achievement of ≥50% target doses, and 30-day, 90-day, and 1-year all-cause and HF readmission and mortality. We adjusted for baseline hospital performance, patient characteristics, and temporal trends. Results: Among 1,274,863 Medicare beneficiaries hospitalized for HFrEF, 53.5% were treated at hospitals that never participated in GWTG-HF and 9.6% at hospitals that joined GWTG-HF before hospitalization. Unadjusted median GDMT scores increased from 3.0 in both groups to 4.0 in non-participating hospitals and 4.5 in GWTG-HF hospitals at 90 days (p<0.001). Hospital enrollment was associated with a higher 90-day GDMT score (+0.15 points; 95% CI 0.12-0.18; p<0.001), and greater use of beta blockers, RASI, and MRA, but not ARNI. HF readmission did not differ significantly; however, GWTG-HF participation was associated with lower all-cause mortality at 30 days (OR 0.95; 95% CI:0.92-0.98), 90 days (OR: 0.97; 95% CI: 0.95-0.99), and 1 year (0.97; 95% CI: 0.95-.0.99; all p<0.05). Conclusion: Hospital participation in GWTG-HF was associated with higher GDMT intensity and lower mortality, supporting structured quality programs to improve HFrEF care.

BACKGROUND: The impact of telemedicine use on heart failure (HF) care is unknown. We assessed the association between telemedicine use and rates of diagnostic testing and prescribing for patients with HF. METHODS: We extracted electronic health record data for patients with HF at an academic cardiovascular center in Northern California. We assigned patients to the cardiologist providing >50% of their visits from March 2019 to May 2023. This interval was divided into 8 nonoverlapping 6-month periods, excluding March through May of 2020. All patients seen and orders placed in each period were included. Orders of interest included diagnostic tests (Holter monitors, electrocardiograms, echocardiograms, natriuretic peptide tests, chemistry panels) and new prescriptions (beta blockers, aldosterone antagonists, renin angiotensin inhibitors, hydralazine, nitrates, total guideline-directed medical therapy, diuretics). We assessed the association between clinician-period ordering rates and telemedicine use (proportion of visits via video/phone) using negative binomial regression with adjustment for the period, number of patients, and clinician random intercepts. We report incident rate ratios of per-patient ordering associated with a 50-percentage-point increase in telemedicine use. Subgroup analyses were conducted for patients with reduced/preserved ejection fraction. RESULTS: There were 7741 patients seen by 44 clinicians (1941 patients with HF with reduced ejection fraction seen by 28 clinicians). Mean age was 65 years (SD, 16.8) with 41% female. A 50-percentage-point increase in telemedicine use was associated with significantly reduced ordering of electrocardiograms (incident rate ratio, 0.30, [95% CI 0.25–0.35]), echocardiograms (0.70 [0.59–0.82]), natriuretic peptide tests (0.66 [0.49–0.88]), and chemistry panels (0.66 [0.56–0.76]). For the HF with reduced ejection fraction subgroup, this increase in telemedicine use was associated with reduced ordering of aldosterone antagonists (0.72 [0.52–0.99]) and total guideline-directed medical therapy (0.80 [0.69–0.94]). CONCLUSIONS: Greater clinician telemedicine use was associated with decreased diagnostic testing for patients with HF and reduced guideline-directed medical therapy initiation for patients with HF with reduced ejection fraction. Novel interventions are needed to ensure guideline-concordant care regardless of care modality.

Background: The prevalence of heart failure with improved ejection fraction (HFimpEF) is growing. The association of ejection fraction (EF) recovery and changes in health status has not been previously reported. We aimed to characterize patient‐reported health status among patients with HFimpEF, heart failure with reduced ejection fraction, and heart failure with midrange (HFmrEF) or preserved ejection fraction (HFpEF). Methods: We identified patients with heart failure with 2 clinic visits, who completed a Kansas City Cardiomyopathy Questionnaire‐12 from August 2020 to October 2023. HFimpEF was defined as most recent EF >40% from a preceding echocardiogram ≥30 days prior with EF ≤40%. We analyzed Kansas City Cardiomyopathy Questionnaire‐12 Overall Summary Score across EF classifications with and without adjustment for patient characteristics via multivariable linear regression. We calculated the R ² to determine the impact of clinical characteristics on variation in health status among patients with HFimpEF. Results: A total of 2519 patients were included, of which 18.7% had HFimpEF, 55.7% had HFmrEF/HFpEF, and 25.6% had HFrEF. Patients with HFimpEF were less likely to be women compared with patients with HFmrEF/HFpEF (41% versus 58%, P P =0.010) but patients with HFimpEF had similar scores as HFmrEF/HFpEF (−1.1 [95% CI, −3.7 to 1.6]; P =0.43). A multivariable regression model explained 16% of the variation in the Overall Summary Score in the HFimpEF subgroup. Conclusions: Despite improvement in EF, patients with HFimpEF continue to have impaired health status similar to HFpEF. Further research is needed to understand and improve health status among patients with HFimpEF.

Background: Guideline‐directed medical therapy (GDMT) improves outcomes in heart failure with reduced ejection fraction, yet its adoption across Asia remains suboptimal. The American Heart Association launched the GWTG‐HF A.S.I.A. (Get With The Guidelines‐Heart Failure Adherence to Science, Implementation in Asia) program in 2021. We examined the association between program participation and GDMT implementation in Taiwan. Methods: We analyzed 1991 patients with heart failure with reduced ejection fraction enrolled in the Taiwan Society of Cardiology HF Registry (2021–2024). Four hospitals participated in the GWTG‐HF A.S.I.A. program (n=462) and 23 nonparticipating hospitals served as controls (n=1529). After propensity‐score matching, prescription trends of 4‐pillar GDMTs were compared using generalized estimating equations. Primary outcomes were patient‐level and hospital‐level GDMT prescription rates; secondary outcomes included echocardiographic remodeling, loss to follow‐up, and 2‐year mortality. Results: Between 2021 and 2024, GDMT use increased in both groups, with greater gains in participating hospitals. Adjusted odds ratios (aOR) for program participation were 2.73 (95% CI, 2.23–3.34) for 4‐pillar GDMTs, 1.59 (95% CI, 1.31–1.92) for angiotensin receptor‐neprilysin inhibitors, 2.06 (95% CI, 1.72–2.47) for SGLT2 (sodium‐glucose co‐transporter 2) inhibitors, and 1.63 (95% CI, 1.34–2.00) for mineralocorticoid receptor antagonists (all P P <0.001), and 2‐year mortality was similar. Conclusions: Participation in the GWTG‐HF A.S.I.A. program was associated with higher GDMT prescription rates in Taiwanese hospitals. Structured quality improvement initiatives may help bridge the evidence‐practice gap in Asia.