ConexiantQuadruple Therapy in HFrEF: What Happens Next?

Only 7.2% of eligible HFrEF patients received guideline-recommended quadruple therapy at discharge across 532 US hospitals. Among those who did, 19% died and 37% faced death or rehospitalization within one year, with median healthcare expenditures near $28,000 per patient.

🩺 Clinical Considerations

• Quadruple therapy does not eliminate high residual risk; mortality and rehospitalization remain substantial even with optimal medical therapy
• Between-hospital variation is marked, suggesting significant gaps in protocol adherence and discharge prescribing practices
• Older patients face compounding mortality risk: median survival drops from 7.4 years (ages 65–69) to 3.1 years (ages 85–89)
• 55% of quadruple-therapy patients experienced at least one all-cause hospitalization within 12 months

🎯 Practice Applications

• Review discharge prescribing protocols to close the 92.8% treatment gap
• Counsel patients that optimal therapy reduces but does not eliminate recurrence risk
• Stratify post-discharge follow-up intensity by age and ejection fraction
• Monitor adherence and dose titration at first post-discharge visit

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