Jan. 6, 2026 — Millions of Americans living with heart failure are not receiving medications that have been proven for decades to significantly reduce the risk of death, according to a new nationwide analysis released by Motive Medical Intelligence, a healthcare data and analytics company.
The study analyzed more than 100 million U.S. medical claims from July 1, 2022, to June 30, 2024, and found that nearly one in three eligible heart failure patients are not being treated with guideline-recommended beta blockers, which are widely available, low-cost medications that can prolong life.
Beta blockers have been a cornerstone of heart failure care for more than 20 years. Clinical trials have demonstrated that these medications decrease heart rate and improve cardiac performance. In patients with heart failure where the heart does not squeeze effectively, beta blockers are highly effective. Professional medical societies have recognized this for years, which is why the American College of Cardiology and the American Heart Association have given their strongest level of recommendation to beta blockers for patients with heart failure.
Yet Motive’s analysis shows that real-world care continues to fall short of this standard.
“There is strong evidence, clear guidelines and affordable therapies available, and yet too many patients are still missing out,” said Richard Klasco, MD, chief medical officer at Motive. “While some states are performing better than others, there is significant room for improvement nationwide.”
Wide Geographic Variations
The analysis found notable differences in care depending on where patients live. The best-performing states — Washington, Minnesota, and South Dakota — had the lowest rates of missed treatment, with about 21% of eligible patients not receiving the appropriate therapy. By contrast, the lowest-performing states, including Arkansas (36%), California (35%), and Louisiana (34%), had more than one-third of eligible patients missing recommended beta blocker medication.
The reasons for these disparities are not fully understood but may include differences in access to care. Also beta blockers must be continued even when patients feel better, which indicates a need for more patient education. Some evidence suggests that interdisciplinary heart failure clinics and electronic reminders may help physicians adhere to the guidelines.
Heart failure already affects an estimated 6.7 million Americans, a number expected to climb to 11.4 million by 2050 as the population ages. The economic impact is equally significant: in 2020, heart failure cost the U.S. an estimated $32 billion in direct and indirect costs, with projections rising as high as $858 billion by mid-century.
Even modest improvements in adherence to evidence-based treatment could have a meaningful impact on both patient outcomes and healthcare spending.
“This is a solvable problem,” said Julie Scherer, PhD, chief solutions officer at Motive, who was directly involved in the recent study. “We consistently see geographic variation in physician performance, but in cases like this — where the cost is low and the benefit is so high —raising awareness among clinicians and patients is essential.”
Dr. Klasco emphasized that patients should always consult with their healthcare provider. “Not all beta blockers are recommended for heart failure, and not all patients qualify,” he said. “The medications shown to improve survival are bisoprolol, carvedilol, and metoprolol succinate, and they are recommended specifically for patients who have heart failure with ‘reduced ejection fraction,’ a common condition in which the heart is too weak to pump out enough blood with each beat.”
November 14, 2025 
