Adherence to Guideline-Directed Medical Therapy in Heart Failure with Reduced Ejection Fraction: A Comparison Between Residents and Attending Physicians

Background Heart failure with reduced ejection fraction (HFrEF) requires adherence to guideline-directed medical therapy (GDMT) for optimal outcomes. This study aimed to assess GDMT adherence at a teaching hospital and compare discharge prescriptions by residents and attending physicians. Methods A retrospective cohort study was conducted at Spring Valley Hospital from August 2023 to March 2024. Patients with HFrEF and decompensated heart failure as the primary reason for admission were identified through electronic health records. Adherence to GDMT at discharge was evaluated based on 2022 American Heart Association (AHA) guidelines, focusing on beta-blockers (BB), angiotensin receptor-neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i). The primary outcome was comparing GDMT adherence between residents and attending physicians. Secondary outcomes included adherence to individual medications, combination regimens, and reasons for non-adherence. Results Among 243 patient charts reviewed, 80 met inclusion criteria (33 residents, 47 attendings). Adherence to beta-blockers was significantly higher than to other GDMT medications (p<0.0001). Residents showed slightly higher adherence to BB, MRA, and SGLT2i, though differences were not statistically significant. Double and triple therapies were prescribed more often than quadruple therapy (p=0.002, p=0.01). Residents demonstrated higher adherence to double therapy with BB and MRA (55% vs. 28%, p=0.02). Conclusion Adherence to GDMT for HFrEF was comparable between residents and attending physicians. Improving adherence to key medications can further enhance HFrEF management and patient outcomes.