Readmission Rates in Reduced Ejection Fraction Heart Failure Patients on Triple Guideline-Directed Medical Therapy at...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Heart failure (HF) significantly burdens healthcare systems, largely due to hospitalizations.
• Guideline-directed medical therapy (GDMT) initiation, especially quadruple therapy, is challenging in HF with reduced ejection fraction (HFrEF) patients with comorbidities.

Purpose of the Study:

• To compare the efficacy and safety of triple GDMT using a sodium-glucose cotransporter inhibitor (SGLTi) versus a mineralocorticoid receptor antagonist (MRA).
• Both SGLTi and MRA were added to existing beta-blocker and ACEi/ARB/ARNi therapy in HFrEF patients.

Main Methods:

• Retrospective cohort study of hospitalized acute HFrEF patients.
• Compared triple GDMT with SGLTi vs MRA at discharge.
• Primary outcome: 90-day readmission for HF; secondary outcomes: 30-day HF readmission and 90-day adverse events.

Main Results:

• 210 patients included (105 SGLTi, 105 MRA).
• 90-day HF readmission rates were 21.90% (SGLTi) vs 14.29% (MRA) (P=0.1516).
• Adjusted analysis showed no significant difference in 90-day HF readmission (aHR=1.742, P=0.1092); adverse event rates were similar.

Conclusions:

• Triple GDMT with SGLTi or MRA in HFrEF patients resulted in comparable 90-day HF hospitalization rates.
• This suggests flexibility in choosing between SGLTi and MRA for triple therapy in this population.