HFpEF Treatment Gaps Start With Identifying the Patient

In an interview with Pharmacy Times, Cody Parsons, APh, PharmD, BCCCP, director of clinical operations in the division of cardiovascular health at Stanford Health Care, discussed the American Heart Association's (AHA) IMPLEMENT-EF initiative and the treatment gaps facing patients with heart failure with preserved ejection fraction (HFpEF) or heart failure with mildly reduced ejection fraction (HFmrEF) ahead of his presentation at the AHA Scientific Sessions 2026, taking place November 6–9 in Chicago, Illinois.

Parsons explained that IMPLEMENT-EF is a 3-year quality improvement initiative launched in 2025 to improve in-hospital care for these patients. He noted that HFpEF and HFmrEF account for as much as 75% of heart failure cases and carry mortality and rehospitalization rates similar to heart failure with reduced ejection fraction, yet research and treatment evidence have lagged. The AHA convened 40 hospitals to map gaps in the patient journey, identify unmet needs, and define ideal care models to scale nationally, using the Get With The Guidelines–Heart Failure dataset to track progress. In year 2, the AHA added a 10-site pharmacy cohort and a 6-month post-discharge dataset.

According to Parsons, the biggest gap starts before treatment. Patients with HFpEF are difficult to identify and may land on noncardiac teams or floors without ever being labeled, delaying the right medications, education, and follow-up. Once patients are identified, prescribing guideline-directed therapies such as sodium-glucose cotransporter 2 (SGLT2) inhibitors remains the main opportunity. A Stanford health equity analysis found that women older than 65 with HFpEF were less likely to receive an SGLT2 inhibitor and, to a lesser degree, a mineralocorticoid receptor antagonist (MRA).

For pharmacists, Parsons said closing the gap means identifying patients, confirming they are on therapy, and intentionally targeting those being left behind.