Up-titration of guideline-directed medical therapy over 9 months was associated with a lower incidence of all-cause death and hospitalisation for worsening HF (adjusted HR 0.65; 95% CI 0.43-0.98).
Cohort (n=680)
Yes
Does up-titration of guideline-directed medical therapy (GDMT) score reduce the composite of all-cause death and hospitalisation for worsening HF in patients with chronic HFrEF?
Up-titration of guideline-directed medical therapy over 9 months is associated with significantly improved clinical outcomes in patients with chronic HFrEF.
Hazard Ratio: 0.65 (95% CI 0.43–0.98)
Abstract Aims Optimisation of guideline-directed medical therapy (GDMT) is a cornerstone of management in heart failure (HF). The GDMT scoring system was developed to quantify both the use and intensification of GDMT. This study investigated the longitudinal changes in the GDMT score and its association with clinical outcomes in contemporary practice. Methods and results This multicentre prospective cohort study included 680 patients with chronic HF with reduced ejection fraction. The patients were classified into the up-titration (n = 282) and no up-titration (n = 398) groups according to changes in the GDMT score over 9 months. The GDMT score incorporated the use and dose of guideline-recommended drugs including quadruple therapy, ivabradine, and vericiguat. The primary outcome was a composite of all-cause death and hospitalisation for worsening HF. Inverse probability of treatment weighting was used to adjust for baseline differences. Up-titration rates at 9 months were 31.8% for renin–angiotensin system blockers, 28.2% for β-blockers, 10.6% for mineralocorticoid receptor antagonists, and 11.9% for sodium–glucose cotransporter 2 inhibitors. Up-titration was independently associated with baseline GDMT score, age, left ventricular ejection fraction, blood pressure, and renal function. Furthermore, up-titration was associated with a lower incidence of the primary outcome than no up-titration (adjusted HR, 0.65; 95% CI, 0.43–0.98). Conclusion In this contemporary chronic HF cohort, the GDMT score incorporating guideline-recommended drugs revealed suboptimal implementation and intensification of GDMT over 9 months. Greater increases in GDMT score were associated with improved clinical outcomes, supporting the clinical relevance of longitudinal GDMT optimisation.
Published in the European Heart Journal - Quality of Care and Clinical Outcomes, this study introduces a scoring system to quantify the implementation of guideline-directed medical therapy in heart failure. The findings highlight suboptimal implementation and are prompting discussions on how to improve adherence to evidence-based therapies.
Tamura et al. (Thu,) conducted a cohort in chronic heart failure with reduced ejection fraction (n=680). Up-titration of guideline-directed medical therapy (GDMT) vs. No up-titration of GDMT was evaluated on Composite of all-cause death and hospitalisation for worsening HF (HR 0.65, 95% CI 0.43-0.98). Up-titration of guideline-directed medical therapy over 9 months was associated with a lower incidence of all-cause death and hospitalisation for worsening HF (adjusted HR 0.65; 95% CI 0.43-0.98).