A scoring evaluation for the practical introduction of guideline-directed medical therapy in heart failure patients

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Guideline-directed medical therapy (GDMT) is crucial for heart failure (HF) management, particularly for patients with reduced ejection fraction (HFrEF).
• Real-world implementation of all recommended GDMT medications can be challenging due to various patient-specific factors.

Purpose of the Study:

• To develop and validate a simple scoring system to assess the adequacy of GDMT in HF patients.
• To investigate the association between this GDMT score and clinical outcomes in patients with HFrEF and HF with mildly reduced ejection fraction (HFmrEF).

Main Methods:

• A retrospective analysis of 1054 hospitalized HF patients (HFrEF and HFmrEF) was conducted.
• A simple GDMT score (0-9 points) was created based on the administration and dosage of four key drug classes: renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose transporter 2 inhibitors.
• Statistical analysis examined the correlation between the GDMT score and outcomes, excluding in-hospital death and dialysis patients.

Main Results:

• A simple GDMT score of ≥5 was significantly associated with a lower risk of all-cause death, HF readmission, and a composite outcome of HF readmission and all-cause death (P < 0.001).
• The number of individual GDMT medications did not show the same significant prognostic association as the GDMT score.
• Subgroup analyses indicated that patients achieving a GDMT score of 5 or higher generally experienced better prognoses.

Conclusions:

• The developed simple GDMT score effectively predicts prognosis in patients with HFrEF and HFmrEF.
• Achieving a GDMT score of ≥5, even without all four drug classes, may be a feasible target to improve outcomes in HF patients.
• This score offers a practical tool for assessing and optimizing GDMT in routine clinical practice.