Authors: Duy Hoang, PhD ⊕Truveta, Inc, Bellevue, WA, Karthik Murugiah, MBBS, MHS ⊕Yale School of Medicine, New Haven, CT, Mitsuaki Sawano, MD, PhD ⊕Yale School of Medicine, New Haven, CT, Brianna M Cartwright, MS ⊕Truveta, Inc, Bellevue, WA, Samuel Gratzl, PhD ⊕, Truveta, Inc, Bellevue, WA, Lesley H Curtis, PhD ⊕, Truveta, Inc, Bellevue, WA, Nicholas L Stucky, MD, PhD ⊕ Truveta, Inc, Bellevue, WA
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.
Published in JAMA Network Open, the study analyzed de-identified electronic health record data from more than 340,000 adults with newly documented HFrEF between 2019 and 2022 using Truveta Data.
Repeat assessment was uncommon
Only 33.8% of patients underwent repeat echocardiography within 12 months of diagnosis, with a median time to reassessment of 155 days. This means that the majority of patients were not reassessed during the period when clinicians would typically look for recovery, worsening, or another change in cardiac function.
Most reassessed patients improved
Among patients who did receive 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, despite strong supporting evidence. Only 12.4% of patients received triple therapy—a combination of three recommended medication classes—during the follow-up period.
Outcomes varied by heart failure trajectory
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.
Why it matters
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. Because the study period ended in 2022, it does not fully reflect the growing adoption of SGLT2 inhibitors and quadruple therapy, underscoring the need to better understand how newer guideline recommendations are being implemented in routine care.
A separate Truveta Research analysis, presented at ISPOR 2026, found that prescribing and dispensing of all four GDMT classes increased from 2020 to 2024, offering a useful follow-on lens for understanding how treatment patterns are evolving.
Read the full study
Heart failure trajectories after guide-line directed medical therapy, JAMA Network Open
