Joined December 2012
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Quadruple GDMT can be simultaneously initiated rapidly uptitrated in ambulatory outpatients
✅ Time to quadruple GDMT optimization 29 days
✅ Safe, well tolerated, efficient
Benefits:
☠️ ⬇️ RR 72.9%
🏥 HF ⬇️ RR 85%
Extend survival 7-11 years
At a 💊 cost of only ~1 a day
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😱 US #HeartFailure mortality is still going ⤴️⤴️⤴️
💔 425,147 HF related ☠️ (45% of all CV ☠️) in 2023
🆘 Yet, massive gaps in GDMT use and HF prevention efforts
Fight back:
🎯 Prevention
🎯Treatment
🎯 Implementation
NOW
#Cardiology #GDMT @ACCinTouch @American_Heart @HFSA
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Despite full access to quadruple GDMT at no or very low out of pocket cost…..
Fewer than one in four patients with HFrEF received quadruple GDMT over 2.9 years of follow-up
Vital need to improve care and outcomes for HFrEF
Among US veterans with #HeartFailure with reduced ejection fraction, fewer than one-quarter achieved quadruple guideline-directed medical therapy within 2.9 years, and medication copays were associated with lower rates of therapy achievement. ja.ma/4ekr9Jf
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💔 Suboptimal uptake of pharmacological treatments in newly diagnosed patients with HF
➡️ Poor prognosis
🎯 Critical to improve implementation of evidence-based therapies within each LVEF subtype
nature.com/articles/s41598-0…
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Jun 12
UCLA-led study finds guideline-directed medical therapy may lower hospitalization-related costs
@MKeykhaeiMD @boback @UCLAHealth @UCLAHealthNews @DOM_UCLA @ATSandhu @MKIttlesonMD @NMHheartdoc @HeartNews @JAMACardio
uclahealth.org/news/release/…
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Would ~$1 a day in medication cost for HFrEF be considered of sufficient value if it resulted in an average of $26 to $63 a day in reduced healthcare expenditures?
@HFSA @ACCinTouch @American_Heart @AAHFN @JAMACardio
jamanetwork.com/journals/jam…
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❤️🩹 HFrEF
💊 ARNI BB MRA SGLT2i
🚀 Ultrafast clinical benefits
☠️ ⬇️⬇️⬇️⬇️
🏨 ⬇️⬇️⬇️⬇️
⚖️ HRQOL ⤴️
Amazing value
🆘 < 2 in 10 eligible treated
❌ Delaying/omitting quadruple GDMT causes preventable ☠️s, 🏨s, and financial toxicity
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Gregg Fonarow MD retweeted
New data: Switching HFrEF patients from no therapy fully generic optimal GDMT cuts projected hospitalization costs by $22,549 (58%) per patient per year.
Even from today’s partial care, full optimization saves $6,240–$8,556/patient/year.
Quadruple therapy works
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Gregg Fonarow MD retweeted
Optimal GDMT doesn’t just save lives — it saves money across every hospitalization category.
Mean 1-year costs vs. No GDMT:
All-cause hosp: $39K → $15K
HF hosp: $17K → $2K
CV hosp: $28K → $4K
Total (Parts A B): $56K → $32K
Even partial GDMT costs MORE than optimal
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Gregg Fonarow MD retweeted
Lower prices could make the value of quadruple GDMT even more compelling 💊📉 At current Cost Plus Drugs cash prices, generic/priced options for HFrEF therapy may cost ~$31/month , about $380/year. This could further amplify the hospitalization cost-offset of optimal GDMT. @gcfmd @SJGreene_md
Jun 11
Quadruple guideline-directed medical therapy in #HeartFailure with reduced ejection fraction was projected to offset hospitalization costs by nearly $10 000 per patient-year, frequently yielding net health care savings.
ja.ma/4eyMQ9I
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Gregg Fonarow MD retweeted
Jun 11
Quadruple guideline-directed medical therapy in #HeartFailure with reduced ejection fraction was projected to offset hospitalization costs by nearly $10 000 per patient-year, frequently yielding net health care savings.
ja.ma/4eyMQ9I
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HFrEF
Step 1: Implement and optimize dosing of quadruple GDMT (ARNI BB MRA SGLT2i)
Cost $380/yr
Step 2: Save 💵
~$22K per yr vs no GDMT
~$10K per yr vs ACEI BB
jamanetwork.com/journals/jam…
@MKeykhaeiMD @NMHheartdoc @SJGreene_md @ATSandhu @MKIttlesonMD @JAMACardio @JAMA_current
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Jun 11
Now available at a monthly cost of only $14.40
AAHFN In the Know
A decade of real-world experience with sacubitril/valsartan (Sac/Val) continues to reinforce what clinical trials first revealed: Sac/Val remains a cornerstone therapy for patients with HFrEF.
Read more:
doi.org/10.1093/eschf/xvag09…
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Gregg Fonarow MD retweeted
Quadruple GDMT for HFrEF at generic pricing costs just $380/year.
📉 vs partial GDMT (2 drugs): saves ~$9,400/patient/year
📉 vs no therapy: saves ~$23,400/patient/year
That’s a 26–63× return on every dollar spent on meds
Barriers to prescribing GDMT are running out of excuses.
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Jun 10
Cost Offset With Quadruple Therapy for Heart Failure
jamanetwork.com/journals/jam……
@MKeykhaeiMD @NMHheartdoc @SJGreene_md @ATSandhu @MKIttlesonMD @JAMACardio @JAMA_current
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Gregg Fonarow MD retweeted
1/🚨Excited to share our new study published in @JAMACardio:
“Cost Offset With Quadruple Therapy for Heart Failure”
jamanetwork.com/journals/jam…
Deeply grateful to Dr. @gcfmd and our amazing team for their unwavering support and mentorship:
@SinaRsh @SJGreene_md @NMHheartdoc @boback @ATSandhu @MKittlesonMD
@uclaCVfellows @DOM_UCLA @uclaimchiefs @UCLAHealth @dgsomucla
#HeartFailure #HFrEF #GDMT
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Cost Offset With Quadruple Therapy for Heart Failure
jamanetwork.com/journals/jam…
@MKeykhaeiMD @NMHheartdoc @SJGreene_md @ATSandhu @MKIttlesonMD @JAMACardio @JAMA_current
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Wow!
$380 in annual medication costs can yield $9,780 to $23,773 in net annual healthcare cost savings in patients with HFrEF
@AHAScience @American_Heart @ACCinTouch @HFSA @AAHFN @robmentz @MKIttlesonMD @ankeetbhatt @JavedButler1 @MariellJessup @HeartDocSadiya @paheidenreich
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Implementation of quadruple GDMT would meaningfully reduce hospitalization-associated costs and yield net savings after accounting for medication expenses
Cost Offset With Quadruple Therapy for Heart Failure jamanetwork.com/journals/jam…
@NMHheartdoc @SJGreene_md @MKIttlesonMD
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Gregg Fonarow MD retweeted
Among patients with #Type2Diabetes and #ChronicKidneyDisease, finerenone reduced risks of cardiovascular and kidney events and promoted regression of #CKM syndrome regardless of baseline stage. ja.ma/4v130yw
ALT Stacked bar charts show CKM stage changes over 3 years for Finerenone vs. Placebo. For baseline CKM stage 2, both groups show increasing progression to higher stages, with placebo slightly worse. For baseline CKM stage 3, Finerenone shows more improvement & less progression.
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