egnite 2026 Benchmark Report: Four-Class GDMT Prescribing in Systolic Heart Failure More Than Doubles, Yet Four in Five Patients Are Not Prescribed Full Guideline Therapy

Real-world data from 47 U.S. health systems shows three-year survival of 76% among systolic heart failure patients prescribed four GDMT classes, versus 52% among those prescribed none

ALISO VIEJO, Calif., Oct. 21, 2026 /PRNewswire/ -- egnite, Inc., a technology company advancing guideline-directed cardiovascular care and real-world evidence, today released its 2026 Benchmark Report on Heart Failure and Structural Heart, which examines how cardiovascular care is delivered across 47 U.S. health systems. It updates the 2023 report and draws on de-identified data from the egnite Registry of more than 15.7 million patients and 6 million echo reports, across 830 facilities in the company's network.

egnite's data shows that prescribing of all four guideline-directed medical therapy (GDMT) classes for systolic heart failure rose from 9% to 21% since the 2023 report, and prescribing of three or more classes rose from 31% to 46%. The growth is consistent with rapid adoption of SGLT2 inhibitors.

New analysis of more than 650,000 real-world systolic heart failure patients featured in the report reveals a strong association between three-year survival and the number of GDMT classes prescribed. Three-year survival was 76% among patients prescribed four classes, compared with 52% among patients prescribed none, a difference of 24 percentage points.

The 2026 egnite Benchmark Report shows how heart failure care is delivered in practice, and where significant gaps remain:

• 79% of systolic heart failure patients are not on four-class GDMT. With documented contraindications rare (under 2% in CHAMP-HF¹), most of the gaps reflect missed opportunities to optimize therapy.
  
  
• The average health system has roughly 1,050 systolic heart failure patients on no GDMT, which puts those patients at risk and adds avoidable strain on acute care resources.
  
  
• The gap is closable: top-performing programs prescribe three or more GDMT classes at 1.4 times the rate of the lowest performers.
  
  
• Only 20% of systolic heart failure patients with two or more hospitalizations in a year have been seen by a heart failure specialist.

"In 2023, fewer than 10% of heart failure with reduced ejection fraction (HFrEF) patients were prescribed all four classes of guideline-directed medical therapy. Today, that figure has more than doubled to 21%--an encouraging sign of how rapidly clinical practice can evolve," said Dr. Rahul Sharma, MBBS, FRACP, Director of Structural Interventions and Associate Director of the Cardiac Catheterization Laboratory at Stanford Health Care, and Senior Medical Advisor of egnite. "Yet most patients remain untreated, with egnite data revealing substantial variation in prescribing practices across providers and institutions." 

Proactive heart programs, such as St. Luke's Heart and Vascular Institute in Chesterfield, MO, use the CardioCare® platform to manage their heart failure patient populations and improve adoption of GDMT. The institute's four-class GDMT rate for systolic heart failure patients increased by 35 percentage points between 2022 and 2026.

"In heart failure, data is your friend. CardioCare gives us benchmarking data and helps identify patients for outreach – allowing us to proactively manage this large population," said Lauren Lindner, MSN, MPH, AGNP-BC, a heart failure clinic Nurse Practitioner for St. Luke's.

Evolving Structural Heart Care

The report also finds that severe tricuspid regurgitation (TR) remains largely untreated. Only 7% of eligible patients with symptomatic severe TR received treatment, up from 6% in 2023, despite two FDA approvals for transcatheter TR therapies in 2024.

While health systems work to close gaps in severe disease, egnite data shows a large untreated moderate AS population. At the median site, there are four untreated moderate aortic stenosis (AS) patients for every untreated severe AS patient, and 68% of those moderate AS patients are symptomatic. The gap is even wider for untreated mitral regurgitation (11:1) and untreated TR (12:1). Patient volumes this large require a deliberate plan for ongoing surveillance, yet at the median site, hundreds of moderate patients have gone more than two years without an echocardiogram.

"At the Transcatheter Cardiovascular Therapeutics (TCT) 2026 conference, I'll share new real-world data from the large egnite Registry on the prevalence of moderate AS compared to severe AS, on the proportion of patients with at least one at-risk feature, and their prognosis over time. The future of aortic stenosis care management requires proactive patient identification, longitudinal monitoring, and active management," said Dr. Philippe Généreux, Director, Structural Heart Disease Program, Morristown Medical Center; Medical Advisory Board, egnite.

About the data
The 2026 Benchmark Report draws on the egnite Registry, a de-identified and longitudinal patient database derived from unified data used daily in patient care. The analysis includes integrated EHR and echocardiographic data from 47 teaching and non-teaching health systems with appropriate permissions for patients echoed or diagnosed between January 1, 2020, and May 31, 2026. Valve disease severity was extracted from echocardiography reports using egnite's proprietary natural language processing, validated at greater than 99% accuracy on 8,000 randomly sampled reports. Findings are observational. The 2023 report reflected 24 health systems; comparisons between the two reports are directional trends in the national benchmark rather than a matched same-site panel. Metric definitions are unchanged between reports.

About egnite, Inc.
egnite, Inc. is a technology company advancing guideline-directed cardiovascular care and real-world evidence. egnite's CardioCare® platform is deployed at more than 80 heart programs, drawing on data from more than 1,200 cardiovascular care facilities in its network, to identify and prioritize cardiovascular patients. CardioCare combines practical AI, clinical logic aligned to ACC/AHA guidelines and workflow integration to help hospitals move more patients into evidence-based care pathways. The egnite Registry, built on de-identified EHR data from approximately 15.7 million patients and 6 million echo reports, gives life sciences and research teams a longitudinal view of the patient journey. The company is headquartered in Aliso Viejo, California. For more information, visit www.egnitehealth.com.

* The CardioCare platform is not intended for use in the diagnosis, cure, mitigation, treatment or prevention of cardiovascular diseases. 

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¹ Greene SJ, Butler J, Albert NM, et al. Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry. J Am Coll Cardiol. 2018;72(4):351-366.

SOURCE egnite Health