Key result
Higher GDMT score linked to ~26% lower 1-year death or HF admission in cardio-renal anemia syndrome.
Why the study?
A simple guideline-directed medical therapy (GDMT) score of ≥5 is associated with prognosis in HFrEF and HFmrEF, but implementing GDMT in patients with Cardio-Renal Anemia Syndrome (CRAS) is challenging and the score's prognostic impact in CRAS was unclear.
Does a simple guideline-directed medical therapy (GDMT) score of ≥5 reduce the 1-year composite of all-cause death or heart failure admission in patients with HFrEF or HFmrEF complicated by cardio-renal anemia syndrome?
Cohort (n=1,615)
Yes
Does a simple guideline-directed medical therapy (GDMT) score of ≥5 reduce the 1-year composite of all-cause death or heart failure admission in patients with HFrEF or HFmrEF complicated by cardio-renal anemia syndrome?
Achieving a simple GDMT score of ≥5 is associated with reduced 1-year all-cause death or HF admission in HFrEF and HFmrEF patients complicated by renal dysfunction and/or anemia.
Answers are grounded in this paper and cite their sources.
May support GDMT optimization in cardio-renal anemia HF; hypothesis-generating and requires prospective trials before practice change.
Background A simple guideline-directed medical therapy (GDMT) score of ≥5, calculated by the combination of GDMT drugs (renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose transporter 2 inhibitors), is associated with prognosis in heart failure with reduced and mildly reduce ejection fraction (HFrEF and HFmrEF). HF patients often complicated Cardio-Renal Anemia Syndrome (CRAS). In addition, the instrument of GDMT for patients with CRAS is often challenging. In addition, its impact of simple GDMT score on prognosis in patients with Cardio-Renal Anemia Syndrome (CRAS) is unclear. Purpose This study aimed to investigate the association between the simple GDMT score and the one-year prognosis of patients HF and CRAS. Methods We analyzed 1,615 HFrEF and HFmrEF patients in QHEART study, a retrospective registry of HF patients admitted to 6 hospitals, including Kyushu university hospital, from October, 2020 to December, 2024. Renal dysfunction (RD) was defined as eGFR<60mL/min/1.73m2 and anemia was defined as Hb<13.0g/dL in males, <12.0g/dL in females. The composite outcome of all-cause death or HF admission during 1 year after discharge was evaluated according to simple GDMT score of ≥5 or less by Cox multivariable analysis. Results We divided these patients into four groups according to the presence/absence of RD and/or anemia; Group 1: RD(-)/anemia(-) (245), Group 2: RD (1,232), Group 3: anemia (814), Group 4: RD(+)/anemia(+) (676). In Group 1, the composite outcome was comparable between patients with simple GDMT score of ≥5 and those of ≤4 (adjusted hazard ratio [aHR]:0.940, 95% confidence interval [CI]:0.408-2.167, p=0.88). On the other hand, the composite outcome was better in patients with simple GDMT score of ≥5 than those of ≤4 in Group2 (aHR:0.766, 95% CI:0.608-0.966, p=0.024). The same trends were observed in Group 3 (aHR:0.713, 95% CI:0.546-0.931, p=0.013) and Group 4 (aHR:0.736, 95% CI:0.553-0.978, p=0.035). Conclusion Simple GDMT score of ≥5 is associated with a better prognosis in HF patients with RD and/or anemia. Optimizing GDMT to reach this target may improve outcome in patients with CRAS.
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Tokumoto et al. (2026) conducted a cohort in Heart failure with reduced or mildly reduced ejection fraction (HFrEF and HFmrEF) and Cardio-Renal Anemia Syndrome (CRAS) (n=1,615). Simple GDMT score ≥5 vs. Simple GDMT score ≤4 was evaluated on Composite outcome of all-cause death or HF admission during 1 year after discharge (aHR 0.736, 95% CI 0.553-0.978, p=0.035). A simple GDMT score of ≥5 was associated with lower 1-year all-cause death or HF admission in HF patients with cardio-renal anemia syndrome (aHR 0.736; 95% CI 0.553-0.978; p=0.035).
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