A significant improvement in the use of guideline-directed quadruple medical therapy (QMT) for heart failure with reduced ejection fraction (HFrEF) has been achieved through the IMPLEMENT-HF initiative, according to results published in Circulation: Heart Failure1. Over two years, participating hospitals increased the rate of defect-free QMT at discharge dramatically—from just 4.7% to 44.6%—and from 0% to 44.8% at 30 days post-discharge.
QMT combines an evidence-based beta-blocker, sodium-glucose cotransporter 2 (SGLT2) inhibitor, angiotensin receptor–neprilysin inhibitor (ARNI), and mineralocorticoid receptor antagonist (MRA). Despite clear evidence of improved survival and reduced hospitalizations, historical implementation rates were below 10%.
The IMPLEMENT-HF quality improvement program involved over 43,500 patients from 61 hospitals across seven US regions, reflecting a diverse population (51% women and 38% from racial and ethnic minority groups). The initiative utilized multidisciplinary learning sessions, electronic health record enhancements, and regular feedback, achieving equitable improvements across demographic groups.
An essential element of the program was the integration of health-related social needs assessments, which rose from near zero to 75.7% at discharge, underscoring the critical role of addressing social determinants of health in patient care.
Dr. Andrew J. Sauer, lead investigator from Saint Luke’s Mid America Heart Institute, emphasized the practical impact of the results. “Structured quality improvement can bridge critical gaps between guidelines and clinical practice, significantly improving patient outcomes,” he noted.
Dr. Mariell Jessup, Chief Medical Officer of the American Heart Association, highlighted that clinician education and system standardization are key components to successfully translating evidence-based guidelines into routine practice.
External experts also recognized the profound potential of these findings. Dr. Gregg C. Fonarow, a heart failure specialist at UCLA, commented, "The impact we could have with optimal implementation of these therapies is profound. Compared to almost anything else we do in cardiology, it’s hard to find treatment effects this large."
For healthcare systems, IMPLEMENT-HF provides a scalable model emphasizing collaborative learning and actionable feedback mechanisms. By improving adherence to QMT, the initiative aims to substantially reduce mortality, hospital readmissions, and improve the quality of life for patients with HFrEF.
This successful approach demonstrates how collaborative, targeted interventions can make guideline-based medicine a reality, ultimately benefiting millions of heart failure patients.
References:
- Sauer AJ, Beon C, Cherkur S, et al. Multiregional Implementation Initiative's Impact on Guideline-Based Performance Measures for Patients Hospitalized With Heart Failure: IMPLEMENT-HF. Circ Heart Fail. 2025 Mar 21:e012547. doi: 10.1161/CIRCHEARTFAILURE.124.012547. Epub ahead of print. PMID: 40115978.