A 1-point increase in guideline-directed medical therapy uptitration score was associated with a lower risk of heart failure hospitalization (HR 0.70; 95% CI 0.61-0.79; P<0.001).
Cohort (n=778)
Does higher baseline GDMT use and GDMT uptitration reduce heart failure hospitalization and mortality in adults with congenital heart disease and HFrEF?
In adults with congenital heart disease and HFrEF, higher baseline GDMT use and subsequent uptitration are associated with significantly lower risks of HF hospitalization and mortality, highlighting a dose-dependent benefit despite current underutilization.
Effect estimate: HR 0.70 (95% CI 0.61-0.79)
p-value: p=<0.001
Background The purpose of this study was to assess the clinical benefits of guideline‐directed medical therapy (GDMT) for heart failure (HF) in adults with congenital heart disease and HF with reduced ejection fraction. Methods HF with reduced ejection fraction was defined as stage B/C HF and systemic left ventricular ejection fraction 0). Higher use of GDMT at baseline (adjusted HR per 1 point increase in GDMT score 0.81, 95% CI, 0.74–0.88, P <0.001), and increased use of GDMT over time (adjusted HR for 1 point increase in ∆GDMT score HR 0.70, 95% CI, 0.61–0.79, P <0.001) were associated with lower risk of HF hospitalization. Higher baseline GDMT score (adjusted HR 0.85, 95% CI, 0.76–0.94, P <0.001), and ∆ GDMT score (adjusted HR 0.82, 95% CI, 0.71–0.94, P <0.000) were also associated with lower mortality. Conclusions GDMT use at baseline and GDMT uptitration were associated with improved outcomes and suggest a dose‐dependent relationship between use of GDMT and risk of adverse outcomes. Furthermore, 67% of patients did not receive GDMT uptitration, suggesting suboptimal therapy, and opportunities for improvement.
Ellabbad et al. (Mon,) conducted a cohort in Adults with congenital heart disease and heart failure with reduced ejection fraction (n=778). Guideline-directed medical therapy (GDMT) baseline use and uptitration vs. Lower baseline use or no uptitration of GDMT was evaluated on Heart failure hospitalization (HR 0.70, 95% CI 0.61-0.79, p=<0.001). A 1-point increase in guideline-directed medical therapy uptitration score was associated with a lower risk of heart failure hospitalization (HR 0.70; 95% CI 0.61-0.79; P<0.001).