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Guideline-Directed Medical Therapies Among Patients With Heart Failure Enrolled in Cardiac Rehabilitation

Claire H Chang1, Tanima Basu, Scott L Hummel

  • 1Author Affiliations: Department of Medicine, University of California, San Francisco, San Francisco, California (Chang); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (Mrs Basu, Dr Hummel, Dr Koelling, Dr Nallamothu, Dr Golbus); Department of Medicine, VA Ann Arbor Health System, Section of Cardiology, Ann Arbor, Michigan (Dr Hummel); Division of Cardiovascular Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan (Dr Keteyian); Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California (Dr Sandhu); and Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan (Dr Dorsch).

Journal of Cardiopulmonary Rehabilitation and Prevention
|February 2, 2026
PubMed

Insights

Guideline-directed medical therapies (GDMT) for heart failure with reduced ejection fraction (HFrEF) remain underutilized in cardiac rehabilitation (CR). Medication optimization scores did not improve, indicating a need for better GDMT prescribing strategies during CR.

Area of Science:

  • Cardiology
  • Clinical Pharmacy
  • Public Health

Background:

  • Cardiac rehabilitation (CR) offers a key opportunity to optimize guideline-directed medical therapies (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF).
  • Understanding current GDMT prescribing patterns within CR is crucial for identifying areas for improvement.

Purpose of the Study:

  • To describe the utilization of GDMT among patients with HFrEF enrolled in a cardiac rehabilitation program.
  • To assess changes in medication optimization scores (MOS) from the start to the end of CR.

Main Methods:

  • A retrospective analysis of electronic health records from an academic medical center identified 152 patients with HFrEF who attended CR between 2016 and 2023.
  • Medication optimization scores (MOS) were calculated using a validated algorithm at the initial and final CR sessions.
  • Wilcoxon Signed-Rank analysis was employed to compare MOS before and after CR.

Main Results:

  • A total of 172 CR cycles were analyzed. At the end of CR, only 49% of patients were on a beta-blocker and 49% on a renin-angiotensin-aldosterone inhibitor.
  • Despite 84% of patients being eligible for GDMT initiation or uptitration, the median MOS remained suboptimal, with no significant change from the start (39%) to the end (35%) of CR (P = .90).

Conclusions:

  • GDMT prescribing for HFrEF patients in CR is suboptimal.
  • There is a significant unmet need and opportunity to develop and implement strategies to enhance GDMT optimization during cardiac rehabilitation programs.
Abstract

Keywords:
cardiac rehabilitationguideline-directed medical therapyheart failure with reduced ejection fraction

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