Validation of a novel Guideline Directed Medical Therapy (GDMT) scoring tool to optimize therapy for patients with heart failure with reduced ejection fraction (HFrEF)

Background: The mortality benefit of guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) is well established. However, contemporary registry data consistently demonstrates substantial gaps in GDMT optimization. A standardized tool to quantify GDMT optimization and target dose achievement may help identify treatment deficits, guide clinical decision-making, and improve associated patient outcomes. Methods: This retrospective, single-center observational study evaluated the internal validity of a novel GDMT scoring tool to quantify GDMT optimization. Adult patients admitted between September 2022 and September 2023 with HFrEF and outpatient follow-up were included. The primary analysis assessed the association between GDMT optimization at 30 days and the risk of 90-day all-cause hospitalization using multivariable logistic regression. Secondary analyses described GDMT optimization rates at 30 days, quadruple therapy rates, and associations between GDMT optimization and 90-day HF hospitalization and all-cause mortality. Results: Eighty-nine patients met inclusion criteria. At 30 days, 76% of patients (n= 68) achieved a GDMT score of ≥ 5 and 24% (n= 21) had a suboptimal GDMT score of <5. Odds of having an all-cause readmission at 90 days were statistically lower in patients with an optimized GDMT Score (OR 0.26, CI 0.09-0.72, P=0.008 ) though no significant differences were observed for HF hospitalizations (OR 0.55 CI 0.17-1.85, P=0.33 ) or all-cause mortality ( P=0.997 ). Conclusion: An optimized GDMT score of ≥ 5 at 30 days was associated with reduced odds of all-cause readmissions at 90 days ( P=0.008 ).