Key result
Post-decongestion RHC linked to ~37% lower death or HF hospitalization in AHF.
Why the study?
Initiating GDMT during hospitalization for AHF remains challenging regarding timing and up-titration. Whether RHC performed after decongestion facilitates GDMT optimization and improves clinical outcomes has not been well established.
Does post-decongestion right heart catheterization improve GDMT optimization and reduce the composite of all-cause death or heart failure hospitalization in patients hospitalized for acute heart failure?
Cohort (n=1,625)
Yes
Does post-decongestion right heart catheterization improve GDMT optimization and reduce the composite of all-cause death or heart failure hospitalization in patients hospitalized for acute heart failure?
In patients hospitalized for acute heart failure (excluding HFpEF), performing right heart catheterization after decongestion is associated with greater optimization of four-pillar GDMT and a lower risk of all-cause death or heart failure hospitalization.
Post-decongestion RHC was associated with optimized GDMT and lower composite risk in acute HF; hypothesis-generating, requiring RCTs before practice change.
Background Initiating guideline-directed medical therapy (GDMT) during hospitalization for acute heart failure (AHF) remains challenging, particularly regarding the optimal timing and appropriateness of up-titration. Right heart catheterization (RHC) performed after decongestion provides detailed hemodynamic information; however, whether it facilitates GDMT optimization and improves clinical outcomes has not been well established. Methods We analyzed 1,625 patients with AHF enrolled in the multicenter retrospective registry “QHEART-R” between October 2020 and December 2024. We excluded patients with HFpEF, in-hospital death, dialysis, or loss to follow-up. Patients were categorized by whether they underwent RHC after decongestion (RHC group; n=731) or not (no-RHC group; n=894). Propensity score matching was performed to balance baseline characteristics (485 matched pairs). GDMT optimization was assessed using the Simple GDMT score. Results In the matched cohort, the RHC group had a higher Simple GDMT score than the no-RHC group (6.1±2.3 vs. 5.2±2.6, p<0.001) and a higher initiation rate of all four foundational therapies (“four pillars”) (49.1% vs. 34.2%, p<0.001). The composite endpoint of all-cause death or hospitalization for heart failure was lower in the RHC group (hazard ratio 0.63, 95% CI 0.485–0.819; p<0.001). Conclusions Among patients hospitalized for AHF, post-decongestion RHC was associated with greater GDMT optimization and improved clinical outcomes.abstract figure
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Ishimaru et al. (2026) conducted a cohort in Acute heart failure (AHF) (n=1,625). Post-decongestion right heart catheterization (RHC) vs. No right heart catheterization after decongestion (no-RHC group) was evaluated on Composite of all-cause death or hospitalization for heart failure (HR 0.63, 95% CI 0.485-0.819, p=<0.001). Post-decongestion RHC in AHF was associated with higher four-pillar GDMT initiation (49.1% vs 34.2%) and lower all-cause death or HF hospitalization (HR 0.63; 95% CI 0.485-0.819; p<0.001).
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