Date of Award

2025

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Melissa Owen

Readers

Benjamin Hocutt

Abstract

Background. Guideline-directed medical therapy (GDMT) is fundamental to the management of heart failure with reduced ejection fraction (HFrEF), yet its utilization remains suboptimal in clinical practice. Despite strong evidence supporting GDMT’s ability to improve survival and reduce hospitalizations, significant underutilization of these medications persist due to patient, provider, and system-level barriers.

Purpose. This project aimed to assess provider knowledge, perceptions, and barriers to prescribing GDMT for HFrEF within a single regional healthcare system. Data from this project will be used to inform targeted quality improvement strategies to enhance GDMT utilization and, ultimately, patient outcomes.

Methods. A cross-sectional survey was distributed to prescriptive providers-including physicians, nurse practitioners, and physician assistants across two acute care hospitals in the Pacific Northwest region facilities in Washington State. The survey examined knowledge of, attitudes toward, and perceived barriers to GDMT utilization. Quantitative analysis using descriptive statistics identified trends and barriers in provider responses.

Results. Nine providers completed the survey, including hospitalists, cardiologists, and advanced practice providers. While 89% of respondents rated themselves as highly familiar with GDMT, most estimated that only 10-50% of eligible inpatients received all four recommended drug classes. Major barriers included anticipated medication side effects, high costs, renal dysfunction, hypotension, and patient complexity. Provider-level obstacles such as unclear role responsibilities and limited familiarity with certain GDMT drug classes further contributed to underutilization of therapy and suboptimal intensification. System-level challenges included resource limitations and poor coordination between care teams.

Conclusion. Despite favorable provider attitudes and knowledge, systemic barriers hinder optimal GDMT prescribing. Targeted interventions-such as structured protocols, ongoing provider education, and decision support tools integrated into electronic health records-may be useful to improve GDMT adoption. Addressing these factors is crucial for closing care gaps and improving outcomes for patients with HFrEF. Findings from this needs assessment will guide future initiatives to overcome barriers and advance heart failure management within the healthcare system.

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