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Updated: Jun 27, 2026

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
09:20

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Published on: February 13, 2021

Gaps in Guideline-Directed Medical Therapy for Heart Failure: A Cross-Sectional Study in an Underserved Population

Ayara O Ehinmisan1, Shilpi Jain-Aggarwal2, Shweta Karki3

  • 1Cardiology, University Hospitals Cleveland Medical Center, Cleveland, USA.

Cureus
|June 26, 2026
PubMed

Insights

Guideline-directed medical therapy (GDMT) for heart failure (HF) is under-prescribed in underserved populations. Targeted interventions are needed to address barriers and improve access to essential HF treatments.

Area of Science:

  • Cardiology
  • Public Health
  • Health Disparities

Background:

  • Heart failure (HF) presents a significant clinical and public health challenge globally.
  • Guideline-directed medical therapy (GDMT) improves HF outcomes, yet significant gaps in its prescription and implementation persist.
  • Understanding GDMT utilization patterns in diverse, underserved populations is crucial for optimizing disease management.

Purpose of the Study:

  • To assess and evaluate the prescribing patterns of GDMTs.
  • Focus on an underserved population within an urban federally qualified health center (FQHC).

Main Methods:

  • Retrospective chart review of patients diagnosed with HF between May 2022 and June 2024.
  • Classification of patients into HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) based on echocardiography.
  • Comparison of baseline demographics and GDMT prescription rates between HFrEF and HFpEF groups.

Main Results:

  • Fifty HF patients identified: 41 with HFrEF and 9 with HFpEF.
  • Significant age difference: HFpEF mean age 68 years vs. HFrEF mean age 58 years (p=0.02).
  • HFrEF GDMT prescription rates: Beta-blockers (BB) 93%, ACEi/ARB/ARNi 83%, MRA 29%, SGLT2 inhibitors 34%. HFpEF prescriptions were similar, except 0% received SGLT2 inhibitors (p=0.05 vs. HFrEF).

Conclusions:

  • GDMT is under-prescribed in underserved populations, indicating a need for targeted interventions.
  • Financial, systemic, and educational barriers contribute to these treatment gaps.
  • Prioritizing patient education, financial counseling, provider training, and policy changes is essential to improve medication access and affordability for HF patients.
Abstract

Keywords:
angiotensin ii receptor blockersangiotensin-converting enzyme inhibitors (acei)beta blockersguideline directed medical therapyhfpef (heart failure with preserved ejection fraction)hfref (heart failure with reduced ejection fraction)mineralocorticoid receptor antagonistsglt-2 inhibitor

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