# Heart Failure With Reduced Ejection Fraction: A Retrospective Cross-Sectional Study of 40 Patients Referred to the Heart Failure Unit at San Juan de Alicante University Hospital

## TL;DR

A hospital study found that referring heart failure patients to a specialized unit significantly improved their treatment and heart function.

## Contribution

Demonstrates that structured Heart Failure Units significantly increase adherence to guideline-directed therapy and improve cardiac function.

## Key findings

- Only 20% of patients received full GDMT at discharge, rising to 52.5% after HFU follow-up.
- Mean LVEF increased significantly from 31.5% to 43.0% after HFU intervention (p < 0.001).
- Men showed a greater improvement in LVEF compared to women.

## Abstract

Introduction/background

Heart failure (HF) is a prevalent clinical syndrome in Spain, often resulting in hospitalizations and significant morbidity. Guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF) is strongly recommended to reduce mortality and improve cardiac function, yet it remains underutilized at hospital discharge. Structured HF Units (HFUs) may improve adherence to GDMT and optimize patient outcomes.

Methods

We conducted a retrospective, descriptive, cross-sectional study including 40 consecutive patients with HFrEF discharged from San Juan de Alicante University Hospital and referred to the HFU. At the HFU visit, patients underwent standardized assessments including medical history review, physical examination, New York Heart Association (NYHA) functional class evaluation, medication optimization according to GDMT, laboratory testing as needed, and repeat echocardiography when indicated. All consecutive eligible patients were included; no formal sample size calculation was performed. Quantitative variables were summarized as mean ± standard deviation and range, and qualitative variables as counts and percentages. Changes in left ventricular ejection fraction (LVEF) were analyzed using the Wilcoxon signed-rank test, while associations with age, sex, and GDMT completeness were evaluated using Spearman’s correlation and Mann-Whitney U tests (p < 0.05).

Results

The mean age of the cohort was 68.1 years (range 41-86), with a predominance of male patients (34 (85%)). At discharge, only eight (20%) received full GDMT, but this proportion more than doubled to 21 (52.5%) after follow-up in the HFU. This improvement was accompanied by a significant rise in mean LVEF from 31.5% to 43.0% (mean increase 11.6%, p < 0.001), with a greater gain observed in men. These findings clearly illustrate that the initially low prescription rate of GDMT at hospital discharge was significantly improved after HFU follow-up, and this optimization was associated with better cardiac function.

Conclusion

GDMT remains frequently underprescribed at hospital discharge, representing a missed opportunity for early optimization. Referral to a structured HFU significantly increases GDMT adherence and improves LVEF, underscoring the critical role of HFUs in multidisciplinary HF care.