Prognostic Impact of a Simple GDMT score on Clinical Outcomes and Cardiac Reverse Remodeling in Patients with ADHF: Insights from the JROADHF-Next

Background It has been reported that implementation rates of guideline-directed medical therapy (GDMT) are associated with improved prognosis and cardiac function in heart failure (HF) patients. This study aimed to investigate the relationship between a simple GDMT score calculated at discharge and subsequent cardiac reverse remodeling and long-term outcomes in patients hospitalized for acute decompensated HF (ADHF), using data from the JROADHF-NEXT prospective registry. Methods We analyzed 2,313 hospitalized patients with HFrEF or HFmrEF, stratifying them into high-score (≥5 points) and low-score (<5 points) groups based on their discharge GDMT score. Results The high-score group demonstrated a significantly lower risk of the composite endpoint of cardiovascular death or HF rehospitalization (HR=0.64, 95% CI: 0.55–0.76), an association that remained significant following multivariable adjustment (adjusted model: HR=0.70, 95%CI:0.56-0.88). Furthermore, the high-score group exhibited significantly greater improvements in echocardiographic indices, including absolute changes in LVEF (left ventricular ejection fraction) (p<0.001), LVEDVI (left ventricular end-diastolic volume index) (p<0.001), and LVESVI (left ventricular end-systolic volume index) (p<0.001), and showed significant reductions in BNP (p=0.005) and NT-proBNP levels (p<0.001) at one-year follow-up. Conclusions A higher simple GDMT score at discharge is independently associated with better 2-year clinical outcomes and favorable cardiac reverse remodeling in this cohort of HFrEF/HFmrEF patients hospitalized for ADHF. These findings suggest that a simple assessment of GDMT at discharge may serve as a practical benchmark of discharge medical optimization in routine clinical care.