Guideline-Directed Medical Therapy After Hospitalization for Acute Heart Failure: Insights From the CONNECT-HF

Area of Science:

• Cardiology
• Clinical Trials
• Pharmacotherapy

Background:

• A significant gap exists in implementing guideline-directed medical therapy (GDMT) for heart failure patients after hospitalization.
• The CONNECT-HF trial investigated a quality improvement intervention for heart failure with reduced ejection fraction.

Purpose of the Study:

• To evaluate the utilization and dose titration of GDMT at hospital discharge and up to 12 months post-discharge.
• To identify factors associated with GDMT use and titration in heart failure patients.

Main Methods:

• Secondary analysis of the CONNECT-HF trial data.
• Examined GDMT use and titration to at least 50% of target dose at discharge and 12 months.
• Included 4646 participants with heart failure with reduced ejection fraction.

Main Results:

• GDMT use did not numerically improve from discharge to 12 months for major drug classes.
• Achievement of ≥50% target dose also showed minimal change over the 12-month period.
• Discharge GDMT use was associated with sustained use and achieving target doses at 12 months.

Conclusions:

• GDMT use remains low and stagnant 12 months after heart failure hospitalization.
• Initiating GDMT during hospitalization is critical for long-term adherence and effectiveness.
• The findings underscore the need for improved strategies to implement and maintain GDMT.