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Updated: Jun 17, 2025
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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
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Determinants of Guideline-Directed Medical Therapy Implementation During Heart Failure Hospitalization
Emily Margolin1, Trina Huynh2, Alison Brann1,3
1Departments of Medicine, University of California-San Diego, San Diego, California, USA.
JACC. Advances
|August 12, 2024
Summary
Guideline-directed medical therapies (GDMTs) for heart failure with reduced ejection fraction (HFrEF) are underused during hospitalizations. Optimizing GDMTs, especially for new-onset HFrEF, significantly reduces mortality and readmissions.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Guideline-directed medical therapies (GDMTs) are proven to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF).
- Despite evidence, the implementation of GDMTs in HFrEF care remains suboptimal, necessitating further investigation into contributing factors and clinical impact.
Purpose of the Study:
- To quantify GDMT implementation rates during acute HFrEF hospitalizations.
- To analyze the relationship between socioeconomic factors and GDMT adherence.
- To assess the impact of GDMT utilization on subsequent clinical events, including mortality and readmissions.
Main Methods:
- A retrospective study analyzed GDMT utilization using a modified optimal medical therapy (mOMT) score in adult patients hospitalized for HFrEF between 2017 and 2018.
- Socioeconomic factors were evaluated for their association with GDMT implementation using Mann-Whitney U and Kruskal-Wallis tests.
- Univariate and multivariable Cox proportional hazards regression models assessed the association between discharge mOMT score and 1-year composite outcomes (all-cause mortality and HF readmission).
Main Results:
- Only 12.5% of patients achieved a near-perfect discharge mOMT score, indicating widespread suboptimal GDMT implementation.
- Black patients and individuals experiencing homelessness demonstrated significantly lower discharge mOMT scores.
- A higher discharge mOMT score was linked to a reduced rate of composite endpoints, with a 0.1-point increase associated with a 9.2% reduction.
Conclusions:
- Suboptimal GDMT implementation during HFrEF hospitalizations is prevalent and associated with adverse clinical outcomes.
- Disparities in GDMT optimization were observed, with Black patients and those experiencing homelessness being less likely to receive optimized therapy.
- Improving GDMT adherence during hospitalization is critical for enhancing patient outcomes in HFrEF.
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