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Temporal changes in guideline-directed medical therapy score and clinical outcomes in patients with heart failure

Toshifumi Tamura1, Toshiyuki Nagai1, Motoki Nakao1

  • 1Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan.

European Heart Journal. Quality of Care & Clinical Outcomes
|June 19, 2026
PubMed

Insights

Optimizing guideline-directed medical therapy (GDMT) in heart failure (HF) is crucial. Increasing the GDMT score over time in HF patients was linked to better clinical outcomes, highlighting the importance of therapy intensification.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Guideline-directed medical therapy (GDMT) optimization is key for managing heart failure (HF).
  • A GDMT scoring system quantifies the use and intensification of GDMT.
  • Longitudinal changes in GDMT scores and their impact on outcomes require investigation in current practice.

Purpose of the Study:

  • To examine longitudinal changes in the GDMT score.
  • To assess the association between GDMT score changes and clinical outcomes in patients with chronic heart failure with reduced ejection fraction (HFrEF).

Main Methods:

  • A multicentre prospective cohort study of 680 HFrEF patients.
  • Patients were grouped into 'up-titration' and 'no up-titration' based on GDMT score changes over 9 months.
  • The GDMT score included quadruple therapy, ivabradine, and vericiguat; outcomes were analyzed using inverse probability of treatment weighting.

Main Results:

  • Up-titration rates at 9 months varied: 31.8% for RAS inhibitors, 28.2% for beta-blockers, 10.6% for MRAs, and 11.9% for SGLT2 inhibitors.
  • Up-titration was associated with baseline GDMT score, age, LVEF, blood pressure, and renal function.
  • Up-titration correlated with a reduced incidence of the primary outcome (all-cause death or HF hospitalization) (aHR, 0.65; 95% CI, 0.43-0.98).

Conclusions:

  • Contemporary HFrEF management shows suboptimal GDMT implementation and intensification over 9 months.
  • Increases in the GDMT score were significantly associated with improved clinical outcomes.
  • Longitudinal optimization of GDMT is clinically relevant and impacts patient prognosis.
Abstract

Keywords:
Guideline-directed medical therapyGuideline-directed medical therapy scoreHeart failure with reduced ejection fraction

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