Simplified GDMT score and all-cause readmission in patients with heart failure: A retrospective cohort study

Guideline-directed medical therapy (GDMT) is the cornerstone of evidence-based heart failure management, yet its real-world implementation remains suboptimal. We adapted a simplified GDMT score to objectively quantify GDMT intensity and provide a practical measure of therapy optimization.

To evaluate the association between a simplified GDMT score with 30-day and 6-month readmissions of HF patients.

We conducted a single-center retrospective cohort analysis including patients with HF with reduced, mildly reduced, and recovered ejection fractions. The primary outcomes were 30-day and 6-month readmissions. Logistic regression models were used to evaluate the association between the GDMT score (high: ≥5 vs. low: <5) and outcomes, with odds ratios (ORs) and 95% confidence intervals as measures of association.

A high GDMT score (≥5) was significantly associated with reduced odds of both 30-day and 6-month readmissions. At 30 days, the odds ratio was 0.51 (95% CI: 0.28-0.93; p = 0.027), and at 6 months, 0.48 (95% CI: 0.29-0.79; p = 0.0055), corresponding to nearly 50% lower odds of hospital readmission. In the ischemic subgroup, the association was more pronounced, with an OR of 0.20 (95% CI: 0.07-0.55; p = 0.0022) for 30-day readmission. COPD independently predicted increased 6-month readmission risk (OR: 1.80; 95% CI: 1.07-3.03; p = 0.027). Age, sex, and BMI were not significant predictors in either model.

A higher simplified GDMT score was associated with reduced 30-day and 6-month readmissions, particularly among patients with ischemic heart failure, supporting its potential utility as a pragmatic measure of GDMT optimization.