Key result
Acute heart failure hospitalization increases GDMT prescriptions, yet only 22% achieve half-target quadruple therapy at discharge.
Why the study?
Patient condition during acute decompensation often limits GDMT optimization, making it essential to assess GDMT implementation at discharge to guide post-hospital care.
Does hospitalization for acutely decompensated heart failure lead to increased prescription and optimization of guideline-directed medical therapy at discharge compared to admission?
Observational (n=262)
Yes
Does hospitalization for acutely decompensated heart failure lead to increased prescription and optimization of guideline-directed medical therapy at discharge compared to admission?
Hospitalization for acutely decompensated heart failure presents a critical opportunity to initiate and up-titrate GDMT, though achieving target doses remains a challenge requiring outpatient follow-up.
Low target-dose GDMT achievement at discharge after acute HF hospitalization suggests outpatient titration is needed; observational data leaves open optimal strategies.
Background/Objectives: Urgent hospitalization due to acutely decompensated heart failure (ADHF) is an unfavorable event in the trajectory of this disease. Patient condition during decompensation frequently limits opportunities to implement and optimize guideline-directed medical therapy (GDMT). To define the tasks of post-hospital care, it is essential to gain knowledge regarding the extent of GDMT implementation on the day of discharge after ADHF episodes. The purpose of this analisis was to evaluate GDMT changes during hospitalization due to ADHF, with a particular emphasis on patients with reduced ejection fraction. Methods: The analysis was conducted in a group of 262 patients hospitalized due to ADHF and with known left ventricular ejection fraction (LVEF). The HEROES study was a prospective, multi-center, observational study. Results: The mean age in the study group (196 men and 66 women) was 67.6 ± 14.6 years, with a mean LVEF of 33.9 ± 14.8%. Six patients died during hospitalization. In the analysis for the whole group (regardless of ejection fraction [EF]), ARNI (angiotensin receptor-neprilysin inhibitor)/ACEI (angiotensin-converting enzyme inhibitor)/ARB (angiotensin receptor blocker) use increased from 63.3% of the subjects at admission to 81.3% at discharge, beta-blocker use increased from 70.6% to 92.6%, MRA (mineralocorticoid receptor antagonist) use increased from 43.1% to 75.8%, and SGLT2i (sodium-glucose co-transporter 2 inhibitor) use increased from 30.1% to 75.0%. ARNI/ACEI/ARB therapy was optimized in 48.4% of the subjects, with optimization rates of 37.9%, 40.2%, and 44.1% for beta-blockers, MRAs, and SGLT2is, respectively. However, only 38 (22.0%) patients reached the level of treatment corresponding to “SGLT2i and ARNI/ACEI/ARB and betablocker and MRA in doses ≥ 50%”. Conclusions: In patients hospitalized due to ADHF in the HEROES study, the use of GDMT at discharge was significantly higher than at admission. In patients with reduced ejection fraction, GDMTs from all drug classes were prescribed to over 80% of patients. However, an insufficient number of patients attained high doses of GDMT, which emphasizes the need for effective dose up-titration in outpatient settings.
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Galas et al. (2025) conducted an observational in Acutely decompensated heart failure (ADHF) (n=262). Hospitalization for ADHF (GDMT optimization) vs. Admission (baseline) was evaluated on Achievement of SGLT2i, ARNI/ACEI/ARB, beta-blocker, and MRA in doses ≥ 50%. Hospitalization for acutely decompensated heart failure increased GDMT prescription rates, but only 22.0% of patients achieved ≥50% of target doses for all four foundational therapies at discharge.
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