Guidelines for the evaluation and management of heart failure recommend different drug therapies for congestive heart failure (CHF) patients with left-ventricular (LV) systolic dysfunction versus those with normal LV systolic function (LVSF). To what extent these guidelines are translated into differing prescribing in actual practice is unknown. OBJECTIVE: To compare drug utilization in hospitalized CHF patients with and without LV systolic dysfunction. METHODS: Medical records were reviewed for all patients with a principle discharge diagnosis of CHF from January 1 through June 30, 1997 at an urban public hospital. (N=387) LVSF assessments performed within 6 months before discharge were used to classify LVSF. Prescribed drug therapies were determined at discharge. RESULTS: Of 207 patients with LV systolic dysfunction, 161 (81.0%) patients were discharged on an angiotensin-converting enzyme (ACE) inhibitor, versus 66 (71.0%) of 93 patients with normal LVSF. (p=0.05) After excluding patients with contraindications of ACE inhibitor use, the difference in ACE inhibitor use between the patients with and without LV systolic dysfunction was not significant. (p=0.09) No statistical significant differences were observed between patients with and without LV systolic dysfunction regarding the utilization of diuretics (90.0% vs. 91.0%), beta blockers (3.0% vs. 4.0%), and alpha blockers. (4.0% vs. 6.0%) CONCLUSIONS: Regardless of LVSF, prescribed drug therapies at discharge were similar among patients hospitalized for CHF in the hospital. Findings indicate a need to better understand the role and actual implementation of guidelines that recommend customized CHF drug therapy tailored to LVSF.