Nationwide Effort Boosts Heart Failure Quad Therapy Use

The IMPLEMENT-HF initiative has significantly increased the adoption of guideline-directed quadruple medical therapy (QMT) for hospitalized patients with heart failure. Over a 2-year period, participating sites observed a sustained increase in QMT use among eligible heart failure patients, from 4.7% at baseline to 44.6% at discharge and from 0% to 44.8% at 30 days post-discharge.

QMT is the combined use of four pharmacologic agents to treat heart failure with reduced ejection fraction. The medications used are evidence-based beta-blockers, sodium-glucose cotransporter-2 (SGLT2) inhibitors, angiotensin receptor-neprilysin inhibitors (ARNIs) or angiotensin-converting enzyme inhibitors (ACEIs), and mineralocorticoid receptor antagonists (MRAs). This combination of drugs has been proven to improve outcomes for patients, with previous research showing prompt initiation of QMT in eligible patients could reduce 2-year mortality by 73%.

Despite strong clinical evidence, fewer than 20% of patients receive QMT when they are diagnosed.  IMPLEMENT-HF was designed to test whether structured, system-level interventions could improve this rate. Designed by the American Heart Association (AHA), IMPLEMENT-HF is a national collaborative of healthcare organizations comprising seven regions throughout the United States, including Kansas City, Chicago, Milwaukee, St Louis, New Jersey, Philadelphia, and rural east-central North Carolina.

Notably, the initiative employed novel techniques and a collaborative learning model that involved hospital-specific data monitoring, enhanced quality consultation from AHA team leads, and performance feedback. The IMPLEMENT-HF initiative analyzed 43,558 patients across 85 hospitals and found significant improvements across all indicators after two years.

A key feature of the initiative was the focus on the social needs assessments at discharge and 30 days after. These assessments aimed to tackle barriers to starting or staying on QMT, including cost concerns, transportation problems, limited health literacy, and lack of follow-up care. This approach enabled care teams to tailor support to patients and connect them with the most relevant resources. Health-related social needs assessment at discharge increased from 4.0% to 75.7% and from 0% to 48.4% at 30 days post-discharge.

“I think this was an important study. This study may create more opportunities in virtual cardiology. With these initiatives, there’s an opportunity to reduce heart failure admissions. This can also, most importantly, improve survival with improved heart function,” noted Mary Branch, MD, MS, a cardiologist with Owensboro Health.

The IMPLEMENT-HF initiative demonstrates that a structured, collaborative approach can drive significant improvements in evidence-based care for HFrEF. The findings provide a replicable model for other healthcare systems seeking to reduce care variation and enhance outcomes in heart failure management.

However, the researchers noted that there was room for future studies to “explore the relationship between enhanced performance measures such as QMT utilization in multidisciplinary team-oriented initiatives such as IMPLEMENT-HF and clinical outcomes”.