Abstract Body: Background:
Guideline-directed medical therapy (GDMT) is a cornerstone of heart failure (HF) management. However, older adults often receive suboptimal treatment due to comorbidities, polypharmacy, or therapeutic caution. Hospitalization represents a key opportunity to optimize GDMT. This study examined whether older adults hospitalized with HFpEF receive GDMT at rates comparable to younger adults.

Methods:
We conducted a retrospective cohort study of adults hospitalized with HF and ejection fraction >40% at the University of Rochester Medical Center over a 24-month period. Prescription data at admission and discharge were obtained from the Get With The Guidelines–Heart Failure registry. Patients with incomplete data or contraindications to any GDMT class were excluded. Participants were stratified by age: younger (<65 years) and older (≥65 years). Within-group changes were assessed using McNemar’s tests and between-group comparisons were performed using χ² tests.

Results:
Of 1,190 patients screened, 724 met inclusion criteria; 69.2% were aged ≥65 years. From admission to discharge, both age groups demonstrated significant increases in prescriptions for SGLT2 inhibitors and aldosterone antagonists (both p < 0.001). In older adults, prescriptions for ACE inhibitors and beta-blockers also increased significantly (both p < 0.01), whereas these changes were not observed in younger adults (p = 0.239 and p = 0.066, respectively). ARB and ARNI use remained unchanged across both groups. At admission, aldosterone antagonist and ARNI use differed by age, but only the difference in aldosterone antagonist prescriptions persisted at discharge.

Conclusions:
Hospitalization was associated with substantial increases in GDMT utilization among patients with HFpEF, particularly for SGLT2 inhibitors and aldosterone antagonists. Nonetheless, age-related differences in prescribing persisted, underscoring ongoing disparities in care for older adults with HFpEF.