{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T03:49:01Z","timestamp":1792986541374,"version":"4.5.0"},"reference-count":51,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec id=\"ab-hoi260009-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Timely prescription of quadruple guideline-directed medical therapies (GDMTs) for patients with heart failure with reduced ejection fraction (HFrEF) is associated with improved morbidity and mortality, yet contemporary estimates of time to quadruple therapy (TTQ) and the factors associated with its achievement remain unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260009-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize TTQ and factors associated with TTQ in HFrEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260009-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This was a retrospective cohort study including patients with incident HFrEF from the Veterans Health Administration database during the January 1, 2020, to December 31, 2023, period. Study data were analyzed from November 2024 to December 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260009-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Primary factors included race and ethnicity, sex, and copay status (priority group). Secondary factors included clinical characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260009-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The main outcome included quadruple therapy according to pharmacy fill data\u2014concurrent use of evidence-based \u03b2-blockers, renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. TTQ was defined as the first date that all 4 medication classes overlapped, based on dispense date and days\u2019 supply.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260009-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 52\u202f850 patients with incident HFrEF (median [SD] age, 71.8 [11] years; 51\u202f473 male [97%]; 10\u202f791 Black [20%]; 2528 Hispanic [5%]; 35\u202f867 White [68%]; 3664 other [7%]), 11\u202f217 (21.2%) achieved quadruple therapy over a median (IQR) follow-up of 2.9 (1.9-3.9) years. The median (IQR) TTQ was 197 (49-528) days. After adjustment, Black patients (hazard ratio [HR], 1.22; 95% CI, 1.15-1.30), Hispanic patients (HR, 1.21; 95% CI, 1.09-1.33), and those from other racial or ethnic groups (HR, 1.11; 95% CI, 1.02-1.20) had higher rates of quadruple therapy than White patients. There was no difference in TTQ in females vs males (HR, 0.97; 95% CI, 0.86-1.09). Prescription copays (priority groups 2-8) were associated with an 8% lower rate of achieving quadruple therapy (HR, 0.92; 95% CI, 0.87-0.96) than no prescription copay (priority group 1). Rates of quadruple therapy were higher among veterans with an outpatient HFrEF diagnosis vs inpatient (22.2% vs 14.2%), with diabetes vs without diabetes (23.6% vs 19.3%), and without chronic kidney disease vs with chronic kidney disease (22.5% vs 18.1%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260009-10\">\n                    <jats:title>Conclusion and Relevance<\/jats:title>\n                    <jats:p>Results of this cohort study suggest that opportunities exist to improve both the rate and timeliness of quadruple therapy as only 21.2% of patients with HFrEF achieved it, with a median follow-up of 2.9 years and TTQ of 6 months. Medication copays represent a modifiable barrier, providing a potential target for interventions to enhance TTQ.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamacardio.2026.0375","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T15:32:58Z","timestamp":1775057578000},"page":"506","source":"Crossref","is-referenced-by-count":9,"title":["Time to Quadruple Therapy After Initial Diagnosis of Heart Failure With Reduced Ejection Fraction"],"prefix":"10.1001","volume":"11","author":[{"given":"Joshua A.","family":"Jacobs","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiovascular Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City"},{"name":"Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City"},{"name":"Department of Pharmacy, University of Utah Health, University of Utah, Salt Lake City"},{"name":"George E. 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