Key result
Four-class GDMT at discharge is linked to ~44% lower 30-day HF readmission versus monotherapy.
Why the study?
GDMT is underutilized at discharge in eligible HF patients, and defining its impact may inform initiatives to reduce high readmissions.
Does increasing the number of guideline-directed medical therapy classes prescribed at hospital discharge reduce 30-day readmissions in adult patients with heart failure with reduced ejection fraction?
Cohort (n=2,121)
Yes
Does increasing the number of guideline-directed medical therapy classes prescribed at hospital discharge reduce 30-day readmissions in adult patients with heart failure with reduced ejection fraction?
Hazard Ratio: 0.56 (95% CI 0.4–0.77)
Prescribing multiple classes of guideline-directed medical therapy at hospital discharge for HFrEF is associated with a robust, dose-dependent reduction in 30-day all-cause and heart failure-specific readmissions.
Supports multi-class GDMT at HFrEF discharge; extends observational data but remains hypothesis-generating pending RCTs.
BACKGROUND: Hospitalization-related costs for heart failure (HF) are a major contributor to the overall health care expenditure in the United States. Despite recommendations, guideline-directed medical therapy (GDMT) is underutilized at discharge in eligible patients, likely contributing to high readmission rates. Describing the effect of GDMT use at discharge may better inform institutions on the value of implementing focused therapy initiatives. OBJECTIVES: This study aimed to examine the association between the number of active GDMT prescriptions at discharge and 30-day readmissions. METHODS: This retrospective cohort study analyzed 2,121 index hospitalizations for HF across 5 institutions from February 1, 2021, to October 31, 2024. Patients included were adults with a baseline left ventricular ejection fraction ≤40%. The primary outcome was 30-day all-cause readmission, and the secondary outcome was 30-day HF readmission. Multivariable mixed-effects Cox proportional hazard models were used to assess the association between GDMT count and readmission rates. RESULTS: Increased GDMT count at discharge was associated with significantly lower hazard of 30-day all-cause readmission: 1 vs 2 GDMT (HR: 0.79; 95% CI: 0.64-0.97), 1 vs 3 GDMT (HR: 0.70; 95% CI: 0.55-0.90), and 1 vs 4 GDMT (HR: 0.56; 95% CI: 0.40-0.77). Trends were similar for HF-specific readmissions. CONCLUSIONS: Increasing number of GDMT classes prescribed at discharge was associated with a gradient reduction in 30-day all-cause and HF readmissions, with a stronger effect seen with higher GDMT counts. Implementing comprehensive GDMT strategies at discharge may reduce health care costs and enhance institutional performance under national quality metrics.
No takes yet. Share an insight, caveat, or question.
Willeford et al. (2025) conducted a cohort in Heart Failure with reduced ejection fraction (HFrEF) (n=2,121). 4 classes of guideline-directed medical therapy (GDMT) vs. 1 class of GDMT was evaluated on 30-day all-cause readmission (HR 0.56, 95% CI 0.40-0.77). Prescription of 4 classes of guideline-directed medical therapy at discharge, compared to 1 class, was associated with a significantly lower hazard of 30-day all-cause readmission in patients with heart failure (HR 0.56).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: