Most patients with newly identified heart failure did not receive repeat heart function assessment, despite guideline recommendations
BELLEVUE, Wash.—May 21, 2026—A new peer-reviewed study led by Truveta and collaborators at Yale School of Medicine, Yale New Haven Hospital, and Duke University School of Medicine found that most patients with newly identified heart failure with reduced ejection fraction (HFrEF) did not receive recommended follow-up assessment of heart function within one year, despite clinical guidelines calling for reassessment and optimization of treatment.
The study, published in JAMA Network Open, analyzed de-identified electronic health record data from more than 340,000 adults with newly documented HFrEF between 2019 and 2022 using Truveta Data, representing care across multiple US health systems.
Researchers found that only 33.8% of patients underwent repeat echocardiography within 12 months of diagnosis, with a median time to reassessment of 155 days. Among patients who received repeat imaging, approximately 71% experienced improvement in heart function, transitioning either to heart failure with improved ejection fraction (HFimpEF) or remission. However, uptake of guideline-directed medical therapy (GDMT) remained modest across all patient groups, including among patients with persistent disease.
“The electronic health record era has made it possible to monitor heart failure care at scale in greater detail and can complement traditional measures of mortality and readmission,” said Karthik Murugiah, MBBS, MHS, Assistant Professor at Yale School of Medicine and co-author of the study. “Understanding the landscape of current heart failure care better is the first step in designing the next generation of performance measures. The sheer size of the Truveta EHR-based dataset provides a unique overview of rates of repeat ventricular assessment in practice and ventricular recovery. Many patients improved substantially, but too many never received the follow-up imaging needed to guide ongoing care and treatment decisions.”
The study also found substantial differences in mortality across heart failure trajectories. Patients with persistent HFrEF experienced the highest 12-month mortality rate at 21.3%, compared with 14.0% among patients with HFimpEF and 11.3% among those whose heart function recovered into remission.
Despite strong evidence supporting guideline-directed therapy, researchers observed low use of recommended medications overall. Only 12.4% of patients received triple therapy—a combination of three recommended medication classes—during the follow-up period.
“These findings show both the opportunity and the challenge in heart failure care today,” said Brianna Cartwright, MS, Director and head of Truveta Research at Truveta and corresponding author of the study. “While patients can experience meaningful recovery in heart function, consistent follow-up, sustained guideline-directed therapy, and ongoing care coordination with their healthcare providers remain essential to supporting improved long-term outcomes.”
The findings highlight the gap between clinical guidelines and real-world practice and underscore the importance of timely reassessment and continued treatment even among patients whose heart function improves. The authors note that improvement in ejection fraction does not necessarily indicate cure and that discontinuation of therapy may increase the risk of relapse.
“Our study demonstrates how large-scale real-world data can help identify where evidence-based care is falling short in practice,” Murugiah added. “Understanding these care patterns is essential to improving implementation and ensuring patients receive appropriate long-term management.”
About the study
The full study, “Heart Failure Trajectories After Guideline-Directed Medical Therapy,” is available online in JAMA Network Open.
About Truveta
Truveta is a real-world intelligence company transforming medical science with unprecedented data and AI. Truveta powers breakthrough discoveries, accelerates regulatory-grade evidence, and unlocks real-time insights from a dataset uniquely built with and owned by US health systems—united by a mission of Saving Lives with Data.
Truveta membership includes: Providence, Advocate Health, Trinity Health, Tenet Healthcare, Northwell Health, AdventHealth, Baptist Health of Northeast Florida, Baylor Scott & White Health, Bon Secours Mercy Health, CommonSpirit Health, Hawaii Pacific Health, HealthPartners, Henry Ford Health System, HonorHealth, Inova, Lehigh Valley Health Network, MedStar Health, Memorial Hermann Health System, MetroHealth, Novant Health, Ochsner Health, Premier Health, Saint Luke’s Health System, Sanford Health, Sentara Healthcare, Texas Health Resources, TriHealth, UnityPoint Health, Virtua Health, and WellSpan Health.