Key result
Residential cardiac rehabilitation linked to improved GDMT optimization after acute heart failure.
Why the study?
Does cardiac rehabilitation improve the optimization of guideline-directed medical therapy in patients with acute heart failure?
Observational (n=263)
Yes
Does cardiac rehabilitation improve the optimization of guideline-directed medical therapy in patients with acute heart failure?
Answers are grounded in this paper and cite their sources.
Admission to residential cardiac rehabilitation after acute heart failure hospitalization is associated with significant optimization of guideline-directed medical therapy across the LVEF spectrum.
Background and aims To provide a contemporary description of patients referred to cardiac rehabilitation (CR) in Italy after hospitalization for acute heart failure (HF), focusing on the use and optimization of guideline-directed medical therapy (GDMT) across the spectrum of left-ventricular ejection fraction (LVEF). Methods PROMETEO is a prospective, multicentre Italian registry enrolling consecutive adult patients admitted to CR after acute HF. Patients were stratified as HFrEF (LVEF <40%) or HFmrEF/HFpEF (LVEF ≥40%). Results Among 263 patients with available LVEF, median age was 68.7 years, 21.7% were female, and 74.9% had HFrEF. Compared with HFmrEF/HFpEF, HFrEF were younger, less frequently female and with higher NT-proBNP levels. At CR admission, 72.1% of HFrEF patients received ACEi/ARB/ARNI, 91.9% beta-blockers, 79.2% MRAs, and 66.0% SGLT2 inhibitors, with a median GDMT score of 6 (IQR 4–8). At discharge, ARNI use increased significantly (58.9%) and the median GDMT score increased to 7 (IQR 4–8; p = 0.013), alongside higher beta-blocker dosing and reduced loop diuretic use. Chronic kidney disease and higher baseline GDMT score were negatively associated with GDMT optimization, while higher BMI showed a positive association. In HFmrEF/HFpEF patients, SGLT2 inhibitor use increased from 28.8% to 47.0% ( p = 0.010), with a concomitant reduction in loop diuretic prescription and dose. Conclusion Patients referred to CR after acute HF are mainly male with HFrEF and show substantial comorbidity and treatment complexity. Residential CR represents a key opportunity for GDMT optimization across the HF spectrum.
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Villaschi et al. (2026) conducted an observational in Acute heart failure (n=263). Residential cardiac rehabilitation vs. Baseline (admission) was evaluated on Median GDMT score at discharge compared to admission (p=0.013). Residential cardiac rehabilitation after acute heart failure optimized guideline-directed medical therapy, increasing the median GDMT score from 6 to 7.
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