Optimal Medical Therapy and Outcomes Among Patients With Chronic Heart Failure With Reduced Ejection Fraction

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Optimal Medical Therapy (OMT) scoring integrates guideline-directed medical therapy (GDMT) use and dosing.
• OMT scoring may stratify clinical risk in chronic heart failure with reduced ejection fraction (HFrEF).

Purpose of the Study:

• To characterize patients and their long-term clinical outcomes based on OMT score-derived treatment groups.
• To evaluate the effectiveness of OMT scoring in risk stratification for HFrEF patients.

Main Methods:

• Utilized data from 4,582 U.S. outpatients with chronic HFrEF in the CHAMP-HF registry.
• Classified patients into suboptimal (<3), acceptable (=3), and optimal (≥4) OMT score subgroups based on GDMT.
• Employed Cox proportional hazard analyses to assess all-cause and cardiovascular death, adjusting for covariates.

Main Results:

• Optimal treatment group (50%) was younger, had higher income, and more likely enrolled in dedicated HF clinics.
• Optimal treatment was associated with significantly lower adjusted hazard ratios for all-cause death (0.77) and cardiovascular death (0.79) compared to suboptimal treatment.
• Suboptimal (35%) and acceptable (14%) treatment groups showed different baseline characteristics and outcomes.

Conclusions:

• OMT scores effectively stratify risk in a large cohort of ambulatory chronic HFrEF patients.
• The OMT scoring system provides valuable prognostic information for guiding HFrEF management.
• Risk stratification using OMT scores can inform clinical decision-making and potentially improve patient outcomes.