Heart Failure Outcomes with Predischarge Guideline Directed Medical Therapy Prescribing Patterns among Hospitalized Patients with Heart Failure with Reduced Ejection Fraction
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Abstract
Objective: To assess the rates of heart failure (HF) readmission or all-cause mortality at 6 months among hospitalized patients with heart failure with reduced ejection fraction (HFrEF) based on the comprehensiveness of guideline-directed medical therapy (GDMT) prescribed at discharge.
Materials and Methods: This therapeutic study with a retrospective cohort design included patients with a first-time hospitalized diagnosis of HFrEF at Vajira Hospital, Faculty of Medicine, Navamindradhiraj University, between January 1, 2018, and May 30, 2022. Patients were categorized into three groups according to the number of GDMT prescribed: GDMT1 (none or one agent), GDMT2 (two agents), and GDMT3 (three agents). The primary outcome is 6-month HF readmission or all-cause mortality were retrospectively collected.
Results: A total of 382 patients (65.2% male, mean age 64.4 ± 14.6 years) were included. Most patients had ischemic cardiomyopathy (43.7%), and the distribution of patients into the three groups was 31.4%, 39.3%, and 29.3% in GDMT1, 2, and 3, respectively. HF readmission or all-cause mortality were significantly lower in patients receiving more comprehensive GDMT: hazard ratio (HR) 0.32 (95% confidence interval (CI): 0.16-0.65, p = 0.001) for GDMT3 versus GDMT1 and HR 0.42 (95% CI: 0.24-0.72, p = 0.002) for GDMT2 versus GDMT1. However, there was no statistically significant difference in the rate of 6-month all-cause mortality among the three groups.
Conclusion: Achieving three GDMT agents before discharge in patients hospitalized with HFrEF is associated with a significant reduction in 6-month HF readmission or all-cause mortality.
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