Economic Impact and Clinical Benefits of Quadruple Guideline-Directed Medical Therapy in Heart Failure with Reduced Ejection Fraction: A Comprehensive Review

Highlights

• Quadruple therapy using ARNI, β-blockers, MRAs, and SGLT2 inhibitors markedly reduces heart failure (HF) and all-cause hospitalizations, translating into substantial cost offsets.
• Real-world Medicare data demonstrate that the implementation of full quadruple GDMT after HFrEF hospitalization can significantly reduce annual hospitalization expenditures by nearly $10,000 per patient.
• The net cost impact of quadruple GDMT varies with drug pricing but predominantly results in overall healthcare savings.
• Complementary evidence from recent RCTs and mechanistic studies supports the safety and efficacy of these agents, including benefits on cardiac function, renal outcomes, and symptomatic improvement.

Background