Related Experiment Video
Updated: Jan 11, 2026
05:16
Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
517
Assessment of Guideline-Directed Medical Therapy Optimization Scores and Readmission Risk in Heart Failure With
Hanna Jensen1, Max Staskauskas1, Sara Strome1
1Department of Pharmacy, UC San Diego Health, San Diego, CA, USA.
The Annals of Pharmacotherapy
|November 14, 2025
Summary
Guideline-directed medical therapy (GDMT) scores like OMT and mOMT predict 90-day heart failure readmissions. Simpler scoring systems show potential for guiding GDMT optimization in heart failure patients.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Heart failure with reduced ejection fraction (HFrEF) has high morbidity and mortality.
- Guideline-directed medical therapy (GDMT) improves HFrEF outcomes but is often underutilized.
- Existing scoring tools for GDMT optimization include GDMT count, Optimal Medical Therapy (OMT), modified OMT (mOMT), and Kansas City Medical Optimization (KCMO).
Purpose of the Study:
- To assess the association between four GDMT scoring systems and 30- and 90-day heart failure (HF) readmissions.
- To determine the predictive value of different GDMT scoring tools for HF readmissions.
Main Methods:
- A multi-center, retrospective cohort study of 544 adult patients hospitalized for HF with left-ventricular ejection fraction ≤40%.
- GDMT scores were calculated at discharge for patients receiving at least one GDMT class and having a healthcare encounter within 90 days.
- Mixed-effects Cox proportional hazards models were used to analyze associations between GDMT scores and 30/90-day HF readmissions, adjusted for covariates.
Main Results:
- 13.1% of patients had 30-day and 26.8% had 90-day HF readmissions.
- No significant association was found between any GDMT score and 30-day readmissions.
- Higher OMT and mOMT scores were associated with reduced 90-day HF readmission risk (HR: 0.93 and 0.94, respectively), while GDMT count and KCMO scores were not.
Conclusions:
- OMT and mOMT scores are associated with 90-day HF readmissions, suggesting their utility in predicting risk.
- GDMT count and KCMO scores did not show significant associations with readmissions in this cohort.
- Further development of GDMT scoring tools is needed, potentially incorporating dose intensity and longitudinal therapy, to better guide optimization efforts for heart failure management.
Related Concept Videos
01:30Heart Failure V: Medical Management
207
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
207
01:22Heart Failure VI: Adjunct Therapies
243
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
243
01:30Heart Failure VII: Nursing Interventions
404
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
404
01:30Heart Failure IV: Classification and Diagnostic Evaluation
305
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
305
01:28Mitral Regurgitation IV: Nursing Management
293
Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
293
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
902
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
902