Review of VHA’s Management of Heart Failure with Reduced Ejection Fraction in Women Veterans

The VA Office of Inspector General (OIG) conducted a national review to determine if Veterans Health Administration’s (VHA) management of heart failure with reduced ejection fraction (HFrEF) in women veterans is consistent with clinical practice guidelines. The OIG reviewed the electronic health records of a representative sample of women veterans with a diagnosis of heart failure and identified 186 with a diagnosis of HFrEF.

The OIG found that all of the women veterans diagnosed with HFrEF were evaluated by a cardiologist consistent with established guidelines. The OIG also found that nearly all women veterans with asymptomatic HFrEF received guideline-directed medical therapy (GDMT) medications in accordance with the national guidelines or had a documented rationale for not prescribing them. Among symptomatic women veterans, most received the recommended GDMT medications or had a documented reason for not being prescribed; however, approximately one in five lacked complete GDMT medication therapy and had no explanation documented.

In the process of reviewing the electronic health records, the OIG determined that VHA does not have a standardized process to efficiently identify HFrEF patients. The team encountered challenges locating information needed to assess adherence to clinical guidelines, including ejection fraction results and documentation that supported treatment decisions. Given that GDMT can reduce mortality by more than 70 percent, reliable identification and monitoring processes are critical. The review highlighted the need for a standardized system to support consistent, evidence based care. 

The OIG made three recommendations. In response, the Under Secretary for Health shared plans to strengthen identification and assessment practices, adherence to GDMT, and documentation of clinical decisions.