Clinical Benefit of Optimization of Heart Failure Therapy After Heart Failure Hospitalization in Adults with CHD

Background Heart failure (HF) hospitalization is a marker of HF progression, and it is associated with mortality in adults with congenital heart disease (CHD). The purpose of this study was to assess the effect of guideline directed medical therapy (GDMT) on HF readmission and mortality in CHD patients with HF with reduced ejection fraction (HFrEF). We hypothesized that higher GDMT use was associated with lower risk of HF readmission and mortality. Method Retrospective study of CHD patients and HFrEF, admitted for HF (2003-2023). GDMT use was assessed at hospital discharge (baseline) and 1-year follow-up using a standardized GDMT score. GDMT uptitration was assessed as difference between GDMT score at baseline versus 1-year follow-up. Results Of 153 patients (age 51±15 years, 39% males, left ventricular EF 29±7%), the median baseline GDMT score was 2 (1, 3). Baseline GDMT score was associated with lower risk of HF readmission (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.54, 0.92, p<0.001) and mortality (HR 0.71, 95%CI 0.50, 0.93, p<0.001) per 1-unit increase in baseline GDMT score. Among patients with 1-year follow-up (N=128), GDMT uptitration was associated with lower risk of HF readmission (HR 0.72, 95%CI 0.49, 0.94, p<0.001) and mortality (HR 0.69, 95%CI 0.41, 0.92, p=0.02) per 1-unit increase. Patients with GDMT uptitration (N=49, 38%) had greater improvement in neurohormonal activation and left ventricular systolic function, consistent with a lower risk of HF readmission and mortality in that group. Conclusions Further studies are required to determine whether strategies to improve GDMT optimization would improve clinical outcomes in this population.