Key result
A low guideline-directed medical therapy score at discharge was independently associated with a higher risk of all-cause mortality or heart failure rehospitalization (HR 1.432) in patients with HFrEF and renal dysfunction.
Why the study?
To examine the association between GDMT intensity at discharge and long-term prognosis in patients with HFrEF and renal dysfunction.
Does a higher guideline-directed medical therapy (GDMT) score at discharge improve the composite of all-cause mortality or heart failure rehospitalization in patients with HFrEF and renal dysfunction?
Cohort (n=626)
No
Does a higher guideline-directed medical therapy (GDMT) score at discharge improve the composite of all-cause mortality or heart failure rehospitalization in patients with HFrEF and renal dysfunction?
Hazard Ratio: 1.432 (95% CI 1.087–1.886)
p-value: p=0.011
A higher guideline-directed medical therapy (GDMT) score at discharge is significantly associated with improved long-term prognosis in high-risk patients with HFrEF and renal dysfunction.
Supports GDMT optimization at discharge in HFrEF with renal dysfunction; hypothesis-generating and leaves open prospective confirmation.
at discharge were included. Results The median GDMT score was 4, and 265 patients (42%) developed the primary outcome during a median follow-up of 24 months. The low-GDMT group had an older age, a reduced renal function, and higher B-type natriuretic peptide (BNP) levels. The incidence of the primary outcome was significantly higher in the low-GDMT group (log-rank p=0.001). In a multivariate analysis, a low GDMT score independently predicted the primary outcomes (hazard ratio: 1.432; 95% confidence interval: 1.087-1.886, p=0.011). The factors associated with low GDMT scores included an older age, higher BNP levels, an absence of diabetes, an absence of implantable cardioverter-defibrillator or cardiac resynchronization therapy, and an absence of oral anticoagulants. Conclusion A higher GDMT score at discharge was significantly associated with an improved prognosis in patients with HFrEF and renal dysfunction. The GDMT score may be a useful tool for assessing treatment appropriateness in this high-risk population.
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Kishihara et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction and renal dysfunction (n=626). Low guideline-directed medical therapy (GDMT) score vs. High GDMT score was evaluated on Composite of all-cause mortality or heart failure rehospitalization (HR 1.432, 95% CI 1.087-1.886, p=0.011). A low guideline-directed medical therapy score at discharge was independently associated with a higher risk of all-cause mortality or heart failure rehospitalization (HR 1.432) in patients with HFrEF and renal dysfunction.
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