What does this research mean for the field?

Initiating guideline-directed medical therapy during hospitalization for heart failure with reduced ejection fraction (HFrEF) results in 90.24% target dose achievement and significantly improves 6-month outcomes. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

January 10, 2026Open Access

Feasibility of inhospital initiation of guideline-directed medical therapy for patients admitted with heart failure with reduced ejection fraction and its clinical outcome at 6 months

Key Result

Initiating guideline-directed medical therapy during hospitalization for HFrEF resulted in 90.24% target dose achievement and significantly improved 6-month outcomes.

Key Points

The study aimed to evaluate the implementation and impact of a structured guideline-directed medical therapy (GDMT) protocol for patients with heart failure with reduced ejection fraction (HFrEF).
Conducted a prospective observational study over 18 months in a tertiary care setting.
Enrolled adults with left ventricular ejection fraction < 40% and no significant valvular disease.
Initiated GDMT during hospitalization and followed patients at 2 weeks, 4 weeks, and 6 months.
Collected data on drug initiation, dose titration, NYHA class, rehospitalization, and mortality.
41.84% of patients received all four GDMT drugs, with 90.24% achieving target dose.
Lower rehospitalization rates (31.71%) were observed in patients receiving all four drugs.
54.54% mortality rate in the group receiving only one drug, significantly higher than other groups.
Target dose achievement was strongly linked to improved functional class and lower 6-month mortality.

Structured PICO

Does in-hospital initiation of a structured GDMT protocol improve target dose achievement, symptoms, and clinical outcomes at 6 months in patients admitted with HFrEF?

Population

98 adult patients (≥18 years) admitted with HFrEF (left ventricular ejection fraction < 40%) without significant valvular disease or reversible causes.

Intervention

In-hospital initiation and uptitration of a structured guideline-directed medical therapy (GDMT) protocol (up to 4 core drugs).

Comparator

Patients receiving fewer GDMT drugs (comparison across 4 groups receiving 4, 3, 2, or 1 GDMT drug).

Outcome

Target dose achievement, clinical improvement in NYHA class, rehospitalization, and mortality at 6 months.hard clinical

In-hospital initiation of comprehensive GDMT for HFrEF is feasible and associated with significantly lower 6-month mortality and rehospitalization compared to partial therapy.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

ABSTRACT Background: Heart failure with reduced ejection fraction (HFrEF) is associated with high morbidity and mortality, and optimal management requires the timely initiation and uptitration of guideline-directed medical therapy (GDMT). Despite strong recommendations, real-world achievement of target doses for core GDMT agents remains suboptimal. This study aimed to evaluate the implementation and impact of a structured GDMT protocol among patients admitted with HFrEF in a tertiary care setting. Methods: A prospective observational study was conducted over 18 months at the Department of Cardiology, Government Medical College, Kozhikode. Adult patients (≥18 years) with left ventricular ejection fraction < 40% and without significant valvular disease or reversible causes were consecutively enrolled. Patients were initiated on GDMT during hospitalization and followed up at 2 weeks, 4 weeks, and 6 months. Data on drug initiation, dose titration, New York Heart Association (NYHA) class, rehospitalization, and mortality were collected using a structured pro forma. Descriptive and inferential statistics were used to assess target dose achievement and clinical outcomes across four patient groups categorized by the number of drugs received. Results: Of the 98 patients enrolled, 41 (41.84%) received all four GDMT drugs (Group 1), of which 37 (90.24%) achieved target dose, while 26 (26.53%) received three drugs (Group 2), of which 22 (84.62%) received target dose, 20 (20.41%) received two drugs (Group 3), and 11 (11.22%) received only one drug (Group 4). Clinical improvement in NYHA class was significantly higher in Groups 1 and 2 ( P < 0.001). Rehospitalization at 6 months was lowest in Group 1 (31.71%) and highest in Group 4 (72.73%). Mortality was significantly higher in Group 4 (54.54%), P < 0.001. Target dose achievement was strongly associated with improved functional class, lower rehospitalization, and reduced mortality. Conclusions: A structured, protocol-based GDMT implementation strategy during hospitalization and early follow-up significantly improved target dose achievement in HFrEF patients. Higher rates of target dose attainment were associated with better 6-month outcomes, including symptom improvement, fewer rehospitalizations, and lower mortality. These findings underscore the importance of early initiation and uptitration of GDMT to improve heart failure outcomes in routine clinical practice.