Key result
GDMT linked to ~54% lower 1-year mortality in malnourished elderly patients with acute HFrEF.
Why the study?
The appropriateness of guideline-directed medical therapy for HFrEF in malnourished elderly patients is unclear.
Does guideline-directed medical therapy reduce all-cause mortality or heart failure readmission in elderly patients (>75 years) with acute heart failure with reduced ejection fraction and malnutrition?
Cohort (n=467)
No
Does guideline-directed medical therapy reduce all-cause mortality or heart failure readmission in elderly patients (>75 years) with acute heart failure with reduced ejection fraction and malnutrition?
Effect estimate: HR 0.46 (95% CI 0.24-0.89)
p-value: p=0.021
Implementation of guideline-directed medical therapy (≥3 HFrEF medications) at discharge is associated with reduced 1-year all-cause mortality in elderly patients (>75 years) with HFrEF and malnutrition.
Supports GDMT consideration in malnourished elderly HFrEF; extends observational data but leaves open randomized confirmation.
Background: The appropriateness of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) in malnourished elderly patients is unclear. This study aims to assess the effects of GDMT on acute heart failure (AHF) with reduced ejection fraction in this specific population using the Geriatric Nutritional Risk Index (GNRI). Methods and Results: We retrospectively collected data of patients aged >75 years who were admitted to St. Luke's International Hospital for AHF with reduced ejection fraction from 2011 to 2022. Malnutrition was defined as a GNRI score <92. GDMT was defined as the prescription of 3 or more of the medications for HFrEF at the time of discharge. Among 467 patients, 345 (73.9%) had malnutrition. In the low GNRI group, GDMT was associated with a lower all-cause mortality at 1 year (HR 0.46; 95% CI 0.24-0.89; P=0.021), but not in heart failure (HF) readmission (HR 0.83; 95% CI 0.55-1.25; P=0.364) at 1 year after discharge. In the high GNRI group, GDMT was not significantly associated with these outcomes (all-cause mortality: HR 0.59; 95% CI 0.12-3.06; P=0.534; HF readmission: HR 0.55; 95% CI 0.29-1.05; P=0.069). Conclusions: Implementation of GDMT in AHF with reduced ejection fraction may enhance prognosis, even among elderly patients with malnutrition.
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Takaoka et al. (2025) conducted a cohort in Acute heart failure with reduced ejection fraction (n=467). Guideline-directed medical therapy (GDMT) vs. No GDMT (<3 HFrEF medications) was evaluated on All-cause mortality at 1 year in patients with malnutrition (low GNRI) (HR 0.46, 95% CI 0.24-0.89, p=0.021). Guideline-directed medical therapy was associated with a 54% reduction in 1-year all-cause mortality (HR 0.46) among malnourished elderly patients hospitalized with acute heart failure with reduced ejection fraction.
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