After hospitalization for heart failure (HF), most new prescriptions for guideline-directed medical therapy (GDMT) went unfilled, and most newly initiated prescriptions did not persist to the six-month mark, according to a recent study published in JAMA Internal Medicine.

Lily Gui Bessette, MS, et al., included 6,111 patients (mean age, 70 years, 37% female) hospitalized for HF. There were four medications of interest, and medication initiation and primary nonadherence were evaluated at seven and 90 days following discharge. Adherence and persistence were also reviewed at the six-month follow-up. At admission, 58% of patients were prescribed β-blockers, 41% renin angiotensin system inhibitors (RASis), 16% MRAs and 5% SGLT2 inhibitors.

At discharge, 51% of patients were prescribed at least one new HF medication, with β-blocker use increasing to 73%, RASis use to 53%, MRA use to 29% and SGLT2 inhibitor use to 9%. Primary nonadherence rates for new prescriptions were 51%, 48%, 39% and 35%, respectively. Overall, only 54% of new prescriptions were initiated within seven days of discharge.

At six months, 42% of patients were adherent and 51% were persistent to all HF medications used at discharge. Broken down by medication, persistence rates were 70%, 60%, 55% and 56%, respectively.

"These findings identify critical windows for targeted interventions to close the gaps in GDMT medication use not only at discharge but also in the weeks to months that follow HF hospitalization," write the authors.

In an accompanying editorial comment, Sarah A. Spinler, PharmD, RPh, CPP, BS, BCCP, FACC; Stormi Gale, PharmD, BCPS, BCCP, FACC; and Kazuhiko Kido, PharmD, BCCP, BCPS, state that the study "confirms what practitioners have always suspected, that initiation of GDMT is a notable initial goal, but the real struggle for adherence and persistence is a long road."