AHA IMPLEMENT-EF initiative aims to improve HFpEF and HFmrEF care

Heart Failure Patients Go Unseen, Untreated

Heart failure patients with preserved ejection fraction (HFpEF) or mildly reduced ejection fraction (HFmrEF) may go unrecognized, delaying guideline-directed therapy, according to an AHA initiative. This is the critical gap identified by the American Heart Association’s (AHA) new, multi-year initiative, which is aiming to overhaul how we treat a specific and often-misunderstood type of heart failure, Pharmacy Times reported.

The initiative, called IMPLEMENT-EF, is a sweeping 3-year quality improvement effort launched in 2025 to tackle the care crisis for patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with mildly reduced ejection fraction (HFmrEF). These conditions account for a staggering 75% of all heart failure cases yet have historically lagged behind in research and effective treatments. According to data analyzed by the AHA, patients with HFpEF face mortality and rehospitalization rates just as high as those with heart failure with reduced ejection fraction, a fact that makes the current care gap all the more alarming.

The Invisibility of a Common Condition

The biggest problem, as Cody Parsons, APh, PharmD, BCCCP, director of clinical operations in cardiovascular health at Stanford Health Care, explained ahead of his presentation at the AHA Scientific Sessions 2026 in Chicago, starts before any prescription is ever written. Patients with HFpEF are notoriously difficult to identify. Their symptoms can be vague and non-specific, leading them to land on noncardiac teams or hospital floors where their underlying heart condition is never properly labeled.

This delay in diagnosis has a direct and devastating impact. These patients miss out on guideline-directed therapies, crucial education on managing their condition, and structured follow-up care that could prevent future hospitalizations. They are essentially invisible in the healthcare system, moving through its corridors without receiving the specialized attention their hearts desperately need. The AHA convened 40 hospitals to map this flawed patient journey, identify exactly where these patients fall through the cracks, and define a new, ideal care model that can be scaled across the country.

A Prescription for Change, and Who’s Being Left Behind

Once a patient is identified, the next major hurdle is ensuring they receive the right medications. Parsons highlighted the underuse of sodium-glucose cotransporter 2 (SGLT2) inhibitors, a class of drugs that has shown significant benefit for patients with heart failure. A health equity analysis conducted at Stanford revealed a troubling disparity: women older than 65 with HFpEF were significantly less likely to be prescribed an SGLT2 inhibitor. They were also, to a lesser degree, less likely to receive a mineralocorticoid receptor antagonist (MRA).

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

Pharmacists, Parsons argued, are uniquely positioned to be the linchpins in this new model of care. Their role is not just dispensing pills, but acting as crucial checkpoints in the patient’s journey. This means actively identifying patients who may have HFpEF, verifying that they are already on the correct guideline-directed therapy, and intentionally focusing their efforts on the demographic groups—like older women—who are consistently being overlooked.

The Data-Driven Road Ahead

The IMPLEMENT-EF initiative is not relying on guesswork. It is built on a foundation of hard data, using the vast Get With The Guidelines–Heart Failure dataset to track progress and measure the impact of its interventions. The initiative is structured to evolve over its three-year span. In the second year, the AHA expanded its reach by adding a 10-site pharmacy cohort and a new 6-month post-discharge dataset. This allows for a more comprehensive view of a patient’s entire care continuum, from the moment they enter the hospital to their recovery at home.

Historically, improving heart failure care has involved sweeping, system-wide changes. The AHA’s goal is to move from a reactive system that treats crises to a proactive one that prevents them, and this initiative is the blueprint for that transformation.

The stakes are immense. For the millions of Americans living with HFpEF and HFmrEF, this isn’t just a medical issue; it’s a matter of daily quality of life and long-term survival. For the healthcare system, it represents a chance to reduce the enormous financial and human cost of repeated hospitalizations. The question is no longer if we can treat these patients better, but whether the healthcare system can finally learn to see them in the first place.