Key result
GDMT score predicts HF hospitalization or death, linking high-risk patients to ~11-fold higher risk.
Why the study?
There is limited evidence on the performance of the GDMT score to predict adverse events in a real-world population.
Does the GDMT score predict heart failure hospitalization and death in patients with HFrEF?
Cohort (n=116)
No
Does the GDMT score predict heart failure hospitalization and death in patients with HFrEF?
Hazard Ratio: 10.9 (95% CI 5–24.19)
p-value: p=<0.001
The GDMT score demonstrates good discriminative ability for predicting the composite of heart failure hospitalization or death in patients with HFrEF.
Background In the current era of guideline-directed medical therapy (GDMT), four categories of medication have been proven beneficial for heart failure with reduced ejection fraction (HFrEF) and are classified as Class I recommendations in the guidelines. The GDMT score was initially developed to objectively assess the degree of GDMT optimization. Currently, there is limited evidence on the performance of GDMT score to predict adverse events in real-world population.. Aim To develop a prediction model for heart failure hospitalization and death based on the GDMT score as a framework for risk stratification. Methods All patients at our hospital heart failure clinic were retrospectively analyzed from the time they registered in the clinic until their first heart failure hospitalization or death occurred. GDMT score was calculated at baseline. Primary outcome was first HF hospitalization or all-cause death. GDMT score was fitted in the Cox proportional hazard model to derive the predicted probability of primary outcome during the follow up. Time to first event analysis on the longest available follow-up data was performed. The patients were categorized into terciles according to the predicted probability of primary outcome. Calibration plot was used to show agreement between predicted and actual outcomes in the terciles. Discrimination was assessed with C-index and Kaplan-Meier curves of outcomes among tercile. Results Between July 2020 and January 2025, 116 patients were included in the study. The primary outcome occurred in 56 patients (48%). The median age of the study population was 64 years [IQR 51, 72], with males comprising the majority (75%) The baseline New York Heart Association functional class for the participants was predominantly III-IV (80%). The average baseline left ventricular ejection fraction (LVEF) was 25%. The C-index of the GDMT score for primary outcome was 0.75 (95% CI [ 0.69 , 0.81]). The unadjusted hazard ratio of the high-risk group compared with the low-risk group was 10.9 (95% CI [5.00, 24.19], P value < 0.001). The calibration plot illustrated good agreement between the predicted probability and Kaplan Meier estimate rate at 1 year of outcome. Conclusions Among patients with HFrEF, the discriminative ability of the GDMT score was good and there was good agreement between predicted and observe adverse events. The score could identify patients with high risk of HF hospitalization or death.
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Buppodom et al. (2025) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=116). High-risk GDMT score vs. Low-risk GDMT score was evaluated on First HF hospitalization or all-cause death (HR 10.9, 95% CI 5.00-24.19, p=<0.001). A high-risk GDMT score was associated with a significantly increased risk of first heart failure hospitalization or all-cause death compared to a low-risk score (HR 10.9; 95% CI 5.00-24.19; P<0.001).
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